Levels of Interleukin 6 as a Predictor of Metabolic Syndrome in Schizophrenic Patients Receiving Combination Therapy of Typical and Atypical Antipsychotics

Abstract

BACKGROUND: Schizophrenia is a severe psychiatric disorder that causes disability and is often accompanied by physical illness. Based on the American Heart Association criteria, metabolic syndrome is common in schizophrenic patients, with a prevalence of 43% in Clinical Antipsychotic Trials of Intervention Effectiveness. The metabolic syndrome in patients with schizophrenia results from the side effects of antipsychotics. The metabolic syndrome will also show high levels of IL-6. This situation can have biological implications, which can then affect the health of schizophrenic patients. AIM: This study aims to determine serum IL-6 levels as a predictor of metabolic syndrome in patients with metabolic syndrome due to side effects of using antipsychotic therapy. METHODS: This prospective cohort study was not randomized, with the number of subjects was 28 schizophrenic patients who were evenly divided into two groups, namely, the group receiving atypical and typical combination therapy. Therapy was given to both groups for 3 months, and measurements and checks of bodyweight, abdominal circumference, blood pressure, BMI, TG, GDP, and Il-6 levels were carried out at baseline and 3rd month. Comparative and correlation tests were carried out between groups. RESULTS: Some schizophrenic patients were categorized as metabolic syndrome and not a metabolic syndrome in both therapy groups (p < 0.020). However, atypical antipsychotic drug combinations are more likely to experience the metabolic syndrome. There was a change in the mean Il-6 levels at baseline and the 3rd month in both groups (p < 0.0001). There was a more excellent mean value of IL-6 levels at 3rd month with metabolic syndrome than those without metabolic syndrome. There was a greater mean value of IL-6 levels at third month with metabolic syndrome compared with those without metabolic syndrome in the haloperidol and chlorpromazine groups (p <0.005), the risperidone and clozapine groups (p <0.002). CONCLUSION: Metabolic syndrome is more common in schizophrenic patients receiving atypical than typical combination therapy. The body’s response to the metabolic syndrome results in an increase in IL-6 levels due to an inflammatory process in visceral fat which accumulates due to weight gain due to the administration of antipsychotics. In schizophrenic patients with metabolic syndrome, IL-6 levels are higher than those without metabolic syndrome, so that IL-6 levels can be used as a predictor of metabolic syndrome in schizophrenic patients receiving antipsychotic therapy.

A systematic review of clozapine‐associated inflammation and related monitoring

“…Significant increases of serum concentration of hs‐CRP were observed weekly after clozapine initiation. Among those studies examining other peripheral inflammatory markers, IL‐6 and TNFα are the most studied proinflammatory cytokines that were found to be elevated after clozapine treatment, 32–36 however, opposite changes 37,38 or no treatment effects 38–40 were also reported. Of note, elevated IL‐6 levels were consistently observed in patients who experienced fever during the initial phase of clozapine treatment, in comparison to those who did not develop fever (for further details, refer to monitoring of non‐specific signs and symptoms of inflammation section).…”

“…19 Significant increases of serum concentration of hs-CRP were observed weekly after clozapine initiation. Among those studies examining other peripheral inflammatory markers, IL-6 and TNFα are the most studied proinflammatory cytokines that were found to be elevated after clozapine treatment, [32][33][34][35][36] however, opposite changes 37,38 or no treatment effects [38][39][40] were also reported. Of note, elevated IL-6 levels were consistently observed in patients who experienced fever during the • Increases of multiple peripheral inflammatory markers were identified under the exposure of clozapine, including TNFα, IL-6, sTNF-Rs, and sIL-R, which were also associated with occurrence of fever.…”

Black Seed (Nigella sativa) Efficacy in Improving Clinical Symptoms and Interleukin-6 Levels Schizophrenic Patients

“…Risperidone can attenuate microglia activation in the brain, which may decrease IL-6 levels [26]. Serum IL-6 levels may also increase after 3 months of taking risperidone and clozapine in patients with the metabolic syndrome [40].…”

Effect of Probiotic Adjuvant Therapy on Improvement of Clinical Symptoms & Interleukin 6 Levels in Patients With Schizophrenia

“…There are also markers of the metabolic syndrome occurring more frequently in patients with schizophrenia receiving atypical than typical combination therapy. 18 The 42 study subjects who received risperidone in both the treatment and control groups were measured for serum IL-6 levels at the baseline and the end of the 6th week. There was also a decrease in baseline IL-6 levels in the treatment group after six weeks with a difference of 3.61 pg/mL (p=0.001), while the control group on the baseline IL-6 with a difference of 2.46 pg/mL (p=0.001).…”

“…Recent studies have shown that antipsychotics can also alter the microbiota. There are also markers of the metabolic syndrome occurring more frequently in patients with schizophrenia receiving atypical than typical combination therapy [ 18 ].…”