International Journal of Psychological and Brain Sciences
Volume 4, Issue 2, April 2019, Pages: 7-12
Received: Apr. 24, 2019;
Accepted: May 24, 2019;
Published: Jun. 10, 2019
Views 136 Downloads 37
Kachouchi Aymen, Research Team for Mental Health, Department of Psychiatry Marrakech, CHU Marrakech, Morocco
Zemrani Yassin, Biochemestry, Laboratory Arrazi, CHU Marrakech, Morocco
Ahroui Yassine, Biochemestry, Laboratory Arrazi, CHU Marrakech, Morocco
Salim Said, Research Team for Mental Health, Department of Psychiatry Marrakech, CHU Marrakech, Morocco
Berghalout Mohammed, Research Team for Mental Health, Department of Psychiatry Marrakech, CHU Marrakech, Morocco
Adali Imane, Research Team for Mental Health, Department of Psychiatry Marrakech, CHU Marrakech, Morocco
Manoudi Fatiha, Research Team for Mental Health, Department of Psychiatry Marrakech, CHU Marrakech, Morocco
Chabaa Laila, Biochemestry, Laboratory Arrazi, CHU Marrakech, Morocco
Asri Fatima, Research Team for Mental Health, Department of Psychiatry Marrakech, CHU Marrakech, Morocco
Recent studies reported firstly an association between aggression and inflammation and secondly an association between inflammation and schizophrenia. In this study, we aim to explore the association between the clinical signs of schizophrenia, aggressive behavior in patients with relapsing schizophrenia and inflammatory marker: CRP (C-reactive protein). Adult schizophrenia inpatients without affective symptoms (n = 154) were prospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP > 5 mg/L; n = 52) or normal (CRP < 5 mg/L; n = 102). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints, injectable treatment 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. Inpatients with elevated C-reactive protein displayed increased aggressive behavior compared to patients with normal CRP levels (<5 mg/L). This was manifested by increased PANSS-EC score (p=0,0001), higher rates of restraint during hospitalization (p=0,0001), higher use of injectable treatment (0,0001) and existence of suicidal behavior (p=0,001). Multivariate analysis revealed that Lymphocyte count, total PANSS score, PANSS excitement score were independently associated with a CRP> 5 mg/L. These results confirm the role played by inflammation and immunity in the appearance of aggressive behavior in schizophrenic patients and highlight the interest of the CRP assay at the admission of patients as an indicator of aggression in hospitalized schizophrenic patients.
C-Reactive Protein and Aggression in Patients with Schizophrenia, International Journal of Psychological and Brain Sciences.
Vol. 4, No. 2,
2019, pp. 7-12.
Ministère de la santé marocain. Enquête nationale sur les prévalences des troubles mentaux en population générale, (ENPTM 2003-2006).
Haute autorité de santé HAS: Dangerosité psychiatrique: étude et évaluation des facteurs de risque de violence hétéro-agressive chez les personnes ayant des troubles schizophréniques ou des troubles de l’humeur (2011).
Volavka J, Laska E, Baker S, Meisner M, Czobor P, Krivelevich I. History of violent behaviour and schizophrenia in different cultures. Analyses based on the WHO study on determinants of outcome of severe mental disorders. Br. J. Psychiatry. 1997; 171, 9-14.
Ketelsen R, Zechert C, Driessen M, Schulz M. Characteristics of aggression in a German psychiatric Hopsital and predictors of patients at risk. J. Psychiatr. Ment. Health. Nurs. 2007; 14:92–99.
El-Badri, S. M., Mellsop, G. Aggressive behaviour in an acute general adult psychiatric unit. Psychiatr. Bull. 2006; 30: 166–168.
Carr V. J, Lewin T. J, Sly K. A, Conrad A. M, Tirupati S, Cohen M and all. Adverse incidents in acute psychiatric inpatient units: rates, correlates and pressures. Aust. N. Z. J Psychiatry. 2008; 42 (4): 267–282.
Ridker P. M. C-Reactive Protein A Simple Test to Help Predict Risk of Heart Attack and Stroke. Circulation. 2003; 108 (12): 81-85.
Miller B. J, Culpepper N, Rapaport, M. H. C-reactive protein levels in schizophrenia: a review and meta-analysis. Clin. Schizophr. Relat. Psychoses. 2014; 7 (4): 223–230.
APA. Diagnostic and statistical manual of mental disorders. 5h ED. Washington DC: American Psychiatric Association; (2014).
Kay S. R, Fiszbein A, Opler L. A. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr. Bull. 1987; 13 (2): 261–276.
Lindenmayer J-P, Brown E, Baker R. W, Schuh L. M, Shao L, Tohen M, and all. An excitement subscale of the Positive and Negative Syndrome Scale. Schizophr. Res. 2014; 68: 331–7.
Montoya A, Valladares A, Lizan L, San L, Escobar R, Paz S. Validation 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; 9:18.
El Yazaji M, Battas O, Agoub M, Moussaoui D, Gutknecht C, Dalery J and all. Validity of the depressive dimension extracted from principal component analysis of the PANSS in drug-free patients with schizophrenia. Schizophr. Res. 2002; 56 (1-2): 121- 7.
Barzilay R, Lobel T, Krivoy A, Shlosberg D, Weizman A, Katz N. Elevated C-reactive protein levels in schizophreniain patients is associated with aggressive behavior. Eur. Psychiatry. 2016: 31: 8–12.
Pan S, Tan Y, Yao S, Zhao X, Xiaong J. Serum high-sensitivity C-reactive protein: A delicate sentinel elevated in drug-free acutely agitated patients with schizophrenia. Psychiatry. Res. 2016; 246:89-94.
Lindqvist D, Janelidze S, Hagell P, Erhardt S, Samuelsson M, Minthom L and all. Interleukin-6 is elevated in the cerebrospinal fluid of suicide attempters and related to symptom severity. Biol. Psychiatry. 2009; 66 (3): 287-92.
Janelidze S, Mattei D, Westrin A, Traskman-Bendz L, Brundin L. Cytokine levels in the blood may distinguish suicide attempters from depressed patients. Brain. Behav Immun. 2011; 25 (2): 335-9.
Solanki R. K, Singh P, Singh M, Sinha M, Swami M. K, Saini S. C-reactive protein (CRP) in patients with schizophrenia: are they related with symptomatology? J. Ment Heal. Hum. Behav. 2009; 15 (1): 6-10.
Fan X, Pristach C, Liu E. Y, Freudenreich O, Henderson D. C, Goff D. C. Elevated serum levels of C-reactive protein are associated with more severe psychopathology in a subgroup of patients with schizophrenia. Psychiatry. Res. 2007; 149:267–71.
Fawzi M. H, Fawzi M. M, Fawzi M. M, Said N. S. C-reactive protein serum level in drug-free male Egyptian patients with schizophrenia. Psychiatry. Res. 2011; 190: 91–7.
Joseph J, Depp C, Sirkin M, Daly R, Glorioso D, Palmer B, and all. Associations of High Sensitivity C-Reactive Protein Levels in Schizophrenia and Comparison Groups. Schizophr. Res. 2015; 168 (0): 456-460.
Dickerson F, Stallings C, Origoni A, Boronow J, Yolken R. C-reactive protein is associated with the severity of cognitive impairment but not of psychiatric symptoms in individuals with schizophrenia. 2007; 93 (1-3):261–5.
Akanji A. O, Ohaeri J. U, Al-Shammri S, Fatania H. R. Association of blood levels of C- reactive protein with clinical phenotypes in Arab schizophrenic patients. Psychiatry. Res. Aug. 2009; 169 (1): 56–61.
Valkanova V, Ebmeier K. P, Allan C. L. CRP, IL-6 and depression: a systematic review and meta-analysis of longitudinal studies. J. Affect. Disord. 2013; 150 (3): 736-44.
Miller B. J, Gassama B, Sebastian D, Buckley P, Mellor A. Meta-Analysis of Lymphocytes in Schizophrenia: Clinical Status and Antipsychotic Effects. Biol. Psychiatry. 2013; 73 (10): 993–999.
Muller N, Riedel M, Scheppach C, Brandstatter B, Sokullu S, Krampe K, and all. Beneficial antipsychotic effects of celecoxib add-on therapy compared to risperidone alone in schizophrenia. Am. J. Psychiatry. 2002; 159 (6):1029-34.
Muller N, Ulmschneider M, Scheppach C, Schwarz M. J, Ackenheil M, Moller H. j., and all. COX-2 inhibition as a treatment approach in schizophrenia: Immunological considerations and clinical effects of celecoxib add-on therapy. Eur. Arch. Psychiatry. Clin. Neurosci. 2004; 254 (1):14-22.
Muller N. Inflammation and the glutamate system in schizophrenia: implications for therapeutic targets and drug development. Expert. Opin. Ther. Targets. 2008; 12 (12): 1497- 507.
Muller N, Krause D, Dehning S, Musil R, Schennach-Wolff R, Obermeier M and all. Celecoxib treatment in an early stage of schizophrenia: results of a randomized, doubleblind, placebo-controlled trial of celecoxib augmentation of amisulpride treatment. Schizophr. Res. 2010; 121 (1-3):118-124.
Akhondzadeh S, Tabatabaee M, Amini H, Ahmadi Abhari S. A, Abbasi S. H, Behnam, B. Celecoxib as adjunctive therapy in schizophrenia: a double-blind, randomized and placebo controlled trial. Schizophr. Res. 2007; Feb 90 (1-3): 179–85.
Laan W, Grobbee D. E, Selten J-P, Heijnen C. J, Kahn R. S, Burger H. Adjuvant aspirin therapy reduces symptoms of schizophrenia spectrum disorders: results from a randomized, double blind, placebo-controlled trial. J. Clin. Psychiatry. 2010; 71:520–7.
Rapaport M, Müller N. Immunological states associated with schizophrenia. Psychoneuroimmunology. 2001; 2: 373–382.
Levkovitz Y, Mendlovich S, Riwkes S, Braw Y, Levkovitch-Verbin H, Gal G, and all. A double-blind, randomized study of minocycline for the treatment of negative and cognitive symptoms in early-phase schizophrenia. J. Clin. Psychiatry. 2010; 71 (2):138–149.
Miyaoka T, Yasukawa R, Yasuda H, Hayashida M, Inagaki T, Horiguchi J. Minocycline as adjunctive therapy for schizophrenia: an open-label study. Clin. Neuropharmacol. 2008; 31:287–292.