Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T16:39:29.324Z Has data issue: false hasContentIssue false
  • English
  • Français

Elevated C-reactive protein levels in schizophrenia inpatients is associated with aggressive behavior

Published online by Cambridge University Press:  23 March 2020

R. Barzilay ,
T. Lobel ,
A. Krivoy ,
D. Shlosberg ,
A. Weizman  and
N. Katz
R. Barzilay*
Affiliation:
Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St. Petah-Tikva, 4910002, Israel Neurosciences laboratory, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
T. Lobel
Affiliation:
Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St. Petah-Tikva, 4910002, Israel
A. Krivoy
Affiliation:
Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St. Petah-Tikva, 4910002, Israel
D. Shlosberg
Affiliation:
Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St. Petah-Tikva, 4910002, Israel
A. Weizman
Affiliation:
Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St. Petah-Tikva, 4910002, Israel
N. Katz
Affiliation:
Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, 1 Helsinki St. Petah-Tikva, 4910002, Israel
*
*Corresponding author. Ran Barzilay, Geha Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. Tel.: +97 2523 020443; fax: +97 2775 251518.E-mail address:[email protected] (R. Barzilay).
Get access

Abstract

Background

An association between inflammation and behavioral domains of mental disorders is of growing interest. Recent studies reported an association between aggression and inflammation. In this study, we investigated the association between aggressive behavior and inflammatory markers in schizophrenia inpatients.

Methods

Adult schizophrenia inpatients without affective symptoms (n = 213) were retrospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP > 1 mg/dL; n = 57) or normal (CRP < 1 mg/dL; n = 156). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints and suicidal behavior during hospitalization. Univariate comparisons between elevated and normal CRP levels were performed and multivariate analysis was conducted to control for relevant covariates.

Results

CRP levels significantly correlated with other laboratory markers indicating increased inflammation including leukocyte count and neutrophil to lymphocyte ratio (r = 0.387, P < 0.0001 and r = 0.356, P < 0.0001) respectively. Inpatients with elevated C-reactive protein displayed increased aggressive behavior compared to patients with normal CRP levels (<1 mg/dL). This was manifested by higher rates of restraint during hospitalization (χ2 = 5.22, P = 0.031) and increased PANSS-EC score (U = 5410.5, P = 0.012). Elevated CRP levels were not associated with suicidal behavior. Multivariate analysis revealed that higher PANSS-EC score was associated with elevated CRP after controlling for the covariates age, sex, BMI and smoking.

Conclusion

This study identified a potential biological correlate (inflammation) of a specific behavioral endophenotype (aggression) in schizophrenia inpatients.

Keywords

SchizophreniaInflammationC-reactive proteinAggressionSuicidal behaviorNeutrophil to lymphocyte ratio
Type
Original article
Information
European Psychiatry , Volume 31 , January 2016 , pp. 8 - 12
Copyright
Copyright © European Psychiatric Association 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Dack, C, Ross, J, Papadopoulos, C, Stewart, D, Bowers, LA review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatr Scand 2013;127:255–268http://dx.doi.org/10.1111/acps.12053.CrossRefGoogle ScholarPubMed
Krakowski, M, Czobor, P, Chou, JCYCourse of violence in patients with schizophrenia: relationship to clinical symptoms. Schizophr Bull 1999;25:505–517.CrossRefGoogle ScholarPubMed
Barlow, K, Grenyer, B, Ilkiw-Lavalle, OPrevalence and precipitants of aggression in psychiatric inpatient units. Aust New Zeal J Psychiatry 2000;34:967–974http://dx.doi.org/10.1080/000486700271.CrossRefGoogle ScholarPubMed
Marsland, AL, Prather, AA, Petersen, KL, Cohen, S, Manuck, SBAntagonistic characteristics are positively associated with inflammatory markers independently of trait negative emotionality. Brain Behav Immun 2008;22:753–761http://dx.doi.org/10.1016/j.bbi.2007.11.008.CrossRefGoogle ScholarPubMed
Coccaro, EFAssociation of C-reactive protein elevation with trait aggression and hostility in personality disordered subjects: a pilot study. J Psychiatr Res 2006;40:460–465http://dx.doi.org/10.1016/j.jpsychires.2005.04.005.CrossRefGoogle Scholar
Coccaro, EF, Lee, R, Coussons-Read, MElevated plasma inflammatory markers in individuals with intermittent explosive disorder and correlation with aggression in humans. JAMA Psychiatry 2014;71:158–165http://dx.doi.org/10.1001/jamapsychiatry.2013.3297.CrossRefGoogle ScholarPubMed
Coccaro, EF, Lee, R, Coussons-Read, MCerebrospinal fluid and plasma C-reactive protein and aggression in personality-disordered subjects: a pilot study. J Neural Transm 2015;122:321–326http://dx.doi.org/10.1007/s00702-014-1263-6.CrossRefGoogle Scholar
Lindqvist, D, Janelidze, S, Hagell, P, Erhardt, S, Samuelsson, M, Minthon, L, et al.Interleukin-6 is elevated in the cerebrospinal fluid of suicide attempters and related to symptom severity. Biol Psychiatry 2009;66:287–292http://dx.doi.org/10.1016/j.biopsych.2009.01.030.CrossRefGoogle ScholarPubMed
Janelidze, S, Mattei, D, Westrin, Å., Träskman-Bendz, L, Brundin, LCytokine levels in the blood may distinguish suicide attempters from depressed patients. Brain Behav Immun 2011;25:335–339http://dx.doi.org/10.1016/j.bbi.2010.10.010.CrossRefGoogle ScholarPubMed
O’Donovan, A, Rush, G, Hoatam, G, Hughes, BM, McCrohan, A, Kelleher, C, et al.Suicidal ideation is associated with elevated inflammation in patients with major depressive disorder. Depress Anxiety 2013;30:307–314http://dx.doi.org/10.1002/da.22087.CrossRefGoogle ScholarPubMed
Dickerson, F, Stallings, C, Origoni, A, Vaughan, C, Khushalani, S, Yang, S, et al.C-reactive protein is elevated in schizophrenia. Schizophr Res 2013;143:198–202http://dx.doi.org/10.1016/j.schres.2012.10.041.CrossRefGoogle Scholar
Dickerson, F, Stallings, C, Origoni, A, Boronow, J, Yolken, RC-reactive protein is associated with the severity of cognitive impairment but not of psychiatric symptoms in individuals with schizophrenia. Schizophr Res 2007;93:261–265http://dx.doi.org/10.1016/j.schres.2007.03.022.CrossRefGoogle Scholar
Fan, X, Pristach, C, Liu, EY, Freudenreich, O, Henderson, DC, Goff, DCElevated serum levels of C-reactive protein are associated with more severe psychopathology in a subgroup of patients with schizophrenia. Psychiatry Res 2007;149:267–271http://dx.doi.org/10.1016/j.psychres.2006.07.011.CrossRefGoogle Scholar
Akanji, AO, Ohaeri, JU, Al-Shammri, S, Fatania, HRAssociation of blood levels of C-reactive protein with clinical phenotypes in Arab schizophrenic patients. Psychiatry Res 2009;169:56–61http://dx.doi.org/10.1016/j.psychres.2008.06.010.CrossRefGoogle ScholarPubMed
Solanki, RK, Singh, P, Singh, M, Sinha, M, Swami, MK, Saini, SC-reactive protein (CRP) in patients with schizophrenia: are they related with symptomatology?. J Ment Heal Hum Behav 2010;6:1–5.Google Scholar
Fawzi, MH, Fawzi, MM, Fawzi, MM, Said, NSC-reactive protein serum level in drug-free male Egyptian patients with schizophrenia. Psychiatry Res 2011;190:91–97http://dx.doi.org/10.1016/j.psychres.2011.05.010.CrossRefGoogle ScholarPubMed
Zahorec, RRatio of neutrophil to lymphocyte counts – rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5–14.Google ScholarPubMed
Ridker, PMCardiology patient page. C-reactive protein: a simple test to help predict risk of heart attack and stroke. Circulation 2003;108:e81–e85http://dx.doi.org/10.1161/01.CIR.0000093381.57779.67.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LAThe positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261–276.CrossRefGoogle Scholar
Lindenmayer, J.-P., Brown, E, Baker, RW, Schuh, LM, Shao, L, Tohen, M, et al.An excitement subscale of the Positive and Negative Syndrome Scale. Schizophr Res 2004;68:331–337http://dx.doi.org/10.1016/S0920-9964(03)00087-2.CrossRefGoogle ScholarPubMed
Huber, CG, Lambert, M, Naber, D, Schacht, A, Hundemer, H.-P., Wagner, TT, et al.Validation of a Clinical Global Impression Scale for Aggression (CGI-A) in a sample of 558 psychiatric patients. Schizophr Res 2008;100:342–348http://dx.doi.org/10.1016/j.schres.2007.12.480.CrossRefGoogle Scholar
Montoya, A, Valladares, A, Lizán, L, San, L, Escobar, R, Paz, SValidation of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room. Health Qual Life Outcomes 2011;9:18http://dx.doi.org/10.1186/1477-7525-9-18.CrossRefGoogle Scholar
Valkanova, V, Ebmeier, KP, Allan, CLCRP, IL-6 and depression: a systematic review and meta-analysis of longitudinal studies. J Affect Disord 2013;150:736–744http://dx.doi.org/10.1016/j.jad.2013.06.004.CrossRefGoogle ScholarPubMed
Gassmann-Mayer, C, Jiang, K, McSorley, P, Arani, R, Dubrava, S, Suryawanshi, S, et al.Clinical and statistical assessment of suicidal ideation and behavior in pharmaceutical trials. Clin Pharmacol Ther 2011;90:554–560http://dx.doi.org/10.1038/clpt.2011.144.CrossRefGoogle ScholarPubMed
Rosell, DR, Siever, LJThe neurobiology of aggression and violence. CNS Spectr 2015;20:254–279http://dx.doi.org/10.1017/S109285291500019X.CrossRefGoogle ScholarPubMed
Hoptman, MJImpulsivity and aggression in schizophrenia: a neural circuitry perspective with implications for treatment. CNS Spectr 2015;20:280–286http://dx.doi.org/10.1017/S1092852915000206.CrossRefGoogle ScholarPubMed
Coccaro, EF, Lee, R, Gozal, DElevated plasma oxidative stress markers in individuals with intermittent explosive disorder and correlation with aggression in humans. Biol Psychiatry 2014 http://dx.doi.org/10.1016/j.biopsych.2014.01.014.CrossRefGoogle Scholar
Beurel, E, Jope, RSInflammation and lithium: clues to mechanisms contributing to suicide-linked traits. Transl Psychiatry 2014;4:e488. http://dx.doi.org/10.1038/tp.2014.129.CrossRefGoogle ScholarPubMed
Baumeister, D, Akhtar, R, Ciufolini, S, Pariante, CM, Mondelli, VChildhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α. Mol Psychiatry 2015 http://dx.doi.org/10.1038/mp.2015.67.CrossRefGoogle Scholar
Swanson, JW, Swartz, MS, Van Dorn, RA, Elbogen, EB, Wagner, HR, Rosenheck, RA, et al.A national study of violent behavior in persons with schizophrenia. Arch Gen Psychiatry 2006;63:490–499http://dx.doi.org/10.1001/archpsyc.63.5.490.CrossRefGoogle ScholarPubMed
Dickerson, F, Stallings, C, Origoni, A, Vaughan, C, Khushalani, S, Yolken, RAdditive effects of elevated C-reactive protein and exposure to herpes simplex virus type 1 on cognitive impairment in individuals with schizophrenia. Schizophr Res 2012;134:83–88http://dx.doi.org/10.1016/j.schres.2011.10.003.CrossRefGoogle ScholarPubMed
Hope, S, Dieset, I, Agartz, I, Steen, NE, Ueland, T, Melle, I, et al.Affective symptoms are associated with markers of inflammation and immune activation in bipolar disorders but not in schizophrenia. J Psychiatr Res 2011;45:1608–1616http://dx.doi.org/10.1016/j.jpsychires.2011.08.003.CrossRefGoogle ScholarPubMed
Collins, AA, Remington, G, Coulter, K, Birkett, KDepression in schizophrenia: a comparison of three measures. Schizophr Res 1996;20:205–209.CrossRefGoogle ScholarPubMed
Kalia, M, Costa, E, Silva, JBiomarkers of psychiatric diseases: current status and future prospects. Metabolism 2015;64:S11–S15. http://dx.doi.org/10.1016/j.metabol.2014.10.026.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.