Immune System Response May Offer Clues About Psychosis, Study Suggests

Analyzing white blood cell counts and levels of C-reactive protein (CRP)—a protein sent to the blood in response to inflammation—in patients with psychosis may offer clues about psychosis severity and treatment response, suggests a study in Schizophrenia Bulletin.

Johann Steiner, M.D., of Otto von Guericke University Magdeburg in Germany and colleagues analyzed blood collected from 253 patients hospitalized for psychosis; this included 129 patients experiencing a first episode of psychosis (FEP) and 124 patients with schizophrenia. All FEP patients were drug-naïve while patients with schizophrenia were unmedicated for at least six weeks prior to the start of the study. White blood cell counts and CRP levels in patients with psychosis were compared with those of people without psychiatric disorders at the start of the study.

Steiner and colleagues found that neutrophils, monocytes, and CRP levels were significantly higher in patients with psychosis compared with those without psychosis at baseline. In contrast, eosinophils were lower at baseline in patients with psychosis. Patients with higher neutrophil counts at baseline tended to report a greater number of positive symptoms on the Positive and Negative Syndrome Scale (PANSS-P), they noted. CRP levels at baseline correlated with PANSS-P in FEP patients but not in patients with schizophrenia.

A total of 163 patients with psychosis then received antipsychotics for six weeks. Although neutrophil counts and CRP levels decreased in these patients following six weeks of medication, these counts remained elevated compared with people without psychosis. In contrast, eosinophil counts increased in patients with psychosis to the point where they did not differ from controls after six weeks of medication. Additional analysis revealed that the degree of positive symptom improvement after treatment correlated with the amount of change in neutrophil, CRP, and/or eosinophil levels.

“[O]ur analysis of routine laboratory parameters such as neutrophil count and CRP levels identified a subgroup of acutely psychotic FEP and [schizophrenia] patients with signs of innate immune system activation,” Steiner and colleagues concluded. “The decline of neutrophils or CRP and rising eosinophils from baseline to follow-up may be considered as markers of treatment response, as these changes correlated with improvement of PANSS-P.”

For related information, see the Psychiatric News article “PET Reveals Inflammatory Response in Schizophrenia, High-Risk Patients.”

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