Association of blood levels of C-reactive protein with clinical phenotypes in Arab schizophrenic patients

Akanji, Abayomi O.; Ohaeri, Jude U.; Al-Shammri, S.; Fatania, Hasmukh R.

doi:10.1016/j.psychres.2008.06.010

Cited by 58 publications

(46 citation statements)

References 32 publications

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“…29 In addition, levels of Creactive protein in serum were reported to be increased in patients with schizophrenia and were even higher in those patients with schizophrenia and prominent catatonic features (P = .04), in comparison to those with schizophrenia but without prominent catatonic symptoms. 30 Patients with catatonic schizophrenia show a different profile of risk factors and outcomes than those with other types of schizophrenia in this cohort study. This lends support to the hypothesis that their etiology differs from other cases and suggests that in future genetic and clinical studies, there may be some benefit from considering this phenotype separately.…”

Section: Discussionmentioning

confidence: 72%

Catatonic Schizophrenia: A Cohort Prospective Study

Kleinhaus

Harlap

Perrin

et al. 2010

Schizophrenia Bulletin

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Background: In the 20th century, catatonia was usually deemed a subtype of schizophrenia. Recently, the nature and classification of catatonia are being reconsidered. This study is the first to describe catatonia using prospectively collected data and to examine how catatonic schizophrenia differs from, or resembles, other types of schizophrenia. Methods: Data were analyzed in a cohort of 90 079 offspring followed from birth till ages 29-41 years. Proportional hazards models were used, calculating time to first psychiatric hospital admission, to compare risk factors for catatonic schizophrenia vs ''other schizophrenia.'' Results: Of 568 cases of schizophrenia, 43 (7.6%) had catatonic schizophrenia. The sexes were equally at risk for catatonic schizophrenia in contrast to other schizophrenia, for which the incidence was higher in males (1.70, 1.42-2.03, P < .0001). Advancing paternal age had no influence on the risk of catatonic schizophrenia in contrast to other schizophrenia, in which the risk to offspring of fathers age 351 was 1.27 (1.03-1.57, P 5 .03) compared with those of younger fathers. Those with catatonic schizophrenia were somewhat more likely to have older mothers (aged 351) (relative risk 5 2.14, 0.85-5.54) while maternal age was not related to other schizophrenia. Both were equally affected by parental history of schizophrenia. Patients with catatonia were significantly more likely to attempt suicide (P 5 .006). Conclusion: Patients with catatonic schizophrenia show a somewhat different profile of risk factors from those with other types of schizophrenia in this cohort and are more likely to attempt suicide. This lends some support to the hypothesis that catatonic schizophrenia may have a distinct etiology.

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Section: Discussionmentioning

confidence: 72%

Catatonic Schizophrenia: A Cohort Prospective Study

Kleinhaus

Harlap

Perrin

et al. 2010

Schizophrenia Bulletin

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“…2 Although no previous studies have examined the association between elevated CRP and schizophrenia prospectively, our results of elevated CRP levels in individuals with vs without schizophrenia are consistent with results in previous case-control studies of 90-400 individuals. [9][10][11]15 Other studies have reported no difference in CRP levels between individuals with vs without schizophrenia [12][13][14] ; however, compared to CRP levels typically reported for the general population, 35 these studies reported much lower mean CRP levels of <0.3 mg/l in both individuals with and without schizophrenia. In contrast, in the former studies showing higher CRP levels in individuals with vs without schizophrenia, 10,11,15 CRP levels in those without schizophrenia were similar to the mean CRP level in our study of 1.7 mg/l, based on 78 810 individuals from the general population.…”

Section: Discussionmentioning

confidence: 78%

“…[6][7][8] Only few studies have examined the association between elevated CRP and schizophrenia, largely in case-control studies. [9][10][11][12][13][14][15] Of these, 4 studies have reported an association between elevated CRP and schizophrenia, [9][10][11]15 whereas the remaining studies reported a null association. [12][13][14] Importantly, to our knowledge, there are no prospective studies of the general population examining the association between baseline elevated CRP and future risk of schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Elevated C-Reactive Protein Associated With Late- and Very-Late-Onset Schizophrenia in the General Population: A Prospective Study

Wium‐Andersen¹,

Ørsted²,

Nordestgaard³

2013

Schizophrenia Bulletin

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Background: Individuals with autoimmune diseases and severe infections have persistent or acutely elevated inflammatory biomarkers and increased risk of schizophrenia. We tested the hypothesis that baseline elevated plasma levels of the inflammatory biomarker, C-reactive protein (CRP), associate with increased risk of late-and very-lateonset schizophrenia in the general population, and if such an association possibly is causal. Method: We analyzed data from 78 810 men and women, aged 20-100 years, from 2 large population studies. Endpoints were hospitalization with schizophrenia and schizophrenia and schizophrenialike psychosis combined. We performed prospective and cross-sectional analyses adjusted for potential confounders with up to 20 years of follow-up. Furthermore, we used genetic variants influencing plasma CRP levels to perform a Mendelian randomization study. Results: Age-and gender-adjusted hazard ratios vs individuals in the first quartile of CRP were 1.7 (95% CI: 0.3-8.9) for second quartile, 2.1 (0.4-10) for third quartile, and 11 (2.8-40) for fourth quartile individuals. The corresponding hazard ratio for fourth quartile individuals after multifactorial adjustment was 5.9 (1.4-24). Furthermore, individuals with vs without schizophrenia had 63% increased plasma levels of CRP (P = 1 × 10 −4 ). Finally, when CRP was on a continuous scale, a doubling in CRP yielded an age-and gender-adjusted observational OR of 1.5 (1.3-1.8) and a corresponding causal OR of 1.4 (0.5-4.3) (observed vs causal: P = .89). Conclusion: Baseline elevated plasma CRP is associated with a 6-to 11-fold increased risk of late-and very-late-onset schizophrenia in the general population. We cannot exclude that this is a causal association. These are novel findings.

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“…Of those, 76 were excluded on the basis of the title and the abstract, leaving 48 studies for further evaluation. Twenty-six studies fulfiled our inclusion criteria, 19 for the between-group meta-analysis of SZ versus control, 14,[17][18][19]21,24,25,[27][28][29][30][31][33][34][35][36]38,39,41 6 for the withingroup meta-analysis of CRP changes after initiation of antipsychotics 20,21,23,27,32,37 and 3 for the within-group metaanalysis of CRP changes with substitution of the type of the antipsychotic. 22,26,40 Some studies provided more than one pairwise comparison, as whenever possible we extracted data according to medication status.…”

Section: Resultsmentioning

confidence: 99%

C-reactive protein is increased in schizophrenia but is not altered by antipsychotics: meta-analysis and implications

et al. 2015

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The inflammatory hypothesis of schizophrenia (SZ) posits that inflammatory processes and neural-immune interactions are involved in its pathogenesis, and may underpin some of its neurobiological correlates. SZ is the psychiatric disorder causing the most severe burden of illness, not just owing to its psychiatric impairment, but also owing to its significant medical comorbidity. C-reactive protein (CRP) is a commonly used biomarker of systemic inflammation worldwide. There are some conflicting results regarding the behaviour of CRP in SZ. The aims of this study were to verify whether peripheral CRP levels are indeed increased in SZ, whether different classes of antipsychotics divergently modulate CRP levels and whether its levels are correlated with positive and negative symptomatology. With that in mind, we performed a meta-analysis of all cross-sectional studies of serum and plasma CRP levels in SZ compared to healthy subjects. In addition, we evaluated longitudinal studies on CRP levels before and after antipsychotic use. Our meta-analyses of CRP in SZ included a total of 26 cross-sectional or longitudinal studies comprising 85 000 participants. CRP levels were moderately increased in persons with SZ regardless of the use of antipsychotics and did not change between the first episode of psychosis and with progression of SZ (g=0.66, 95% confidence interval (95% CI) 0.43 to 0.88, P<0.001, 24 between-group comparisons, n=82 962). The extent of the increase in peripheral CRP levels paralleled the increase in severity of positive symptoms, but was unrelated to the severity of negative symptoms. CRP levels were also aligned with an increased body mass index. Conversely, higher age correlated with a smaller difference in CRP levels between persons with SZ and controls. Furthermore, CRP levels did not increase after initiation of antipsychotic medication notwithstanding whether these were typical or atypical antipsychotics (g=0.01, 95% CI -0.20 to 0.22, P=0.803, 8 within-group comparisons, n=713). In summary, our study provides further evidence of the inflammatory hypothesis of SZ. Whether there is a causal relationship between higher CRP levels and the development of SZ and aggravation of psychotic symptoms, or whether they are solely a marker of systemic low-grade inflammation in SZ, remains to be clarified.

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Association of blood levels of C-reactive protein with clinical phenotypes in Arab schizophrenic patients

Cited by 58 publications

References 32 publications

Catatonic Schizophrenia: A Cohort Prospective Study

Catatonic Schizophrenia: A Cohort Prospective Study

Elevated C-Reactive Protein Associated With Late- and Very-Late-Onset Schizophrenia in the General Population: A Prospective Study

C-reactive protein is increased in schizophrenia but is not altered by antipsychotics: meta-analysis and implications

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