The effect of electroconvulsive therapy on hematologic inflammatory markers in schizophrenia in association with type of antipsychotic medication

Year 2020, Volume: 6 Issue: 3, 238 - 247, 04.05.2020

Sinay Önen İbrahim Taymur

https://doi.org/10.18621/eurj.586551

Cited By: 1

Abstract

Objectives: In recent years there has been an increased interest on the role of inflammation in the pathophysiology of schizophrenia and a search for readily applicable prognostic markers. The impact of electroconvulsive therapy (ECT) on inflammatory function in schizophrenia is still unclear. The aim of this retrospective study is to compare pre- and post-ECT values of red cell distribution width (RDW), mean platelet volume (MPV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) which are considered to be inflammatory markers, and to discuss the findings in context of neuroinflammatory ethiology of schizophrenia.

Methods: Inpatient files were reviewed via complete blood count (CBC), sociodemographic and clinical characteristics (e.g. gender, age, Body Mass Index (BMI), type of psychotropic medication). A total of 58 schizophrenic patients who underwent ECT were were compared in terms of pre- and post-ECT values of RDW, MPV, MCH, MCHC, NLR and PLR in association with type of psychotropic medication.

Results: It was found that MPV, RDW, MCH and MCHC levels significantly decreased after ECT (p < 0.05), but no significant difference was found in terms of NLR and PLR (p > 0.05). When compared according to the type of psychotropic medication during ECT, MPV and MCHC were decreased after ECT in both typicaland atypical antipsychoticintervention groups (p < 0.05). ECT-related inflammatory marker changes were more likely to be associated with atypical antipsychotic medication use during ECT.

Conclusions: Our results indicate that recurrent ECT sessions caused a change in the function of the immune system which might be considered to explain the therapeutic effects of ECT in schizophrenia. 

Keywords

electroconvulsive therapy, schizophrenia, inflammatory markers, antipsychotic medication, immune system

Supporting Institution

The author disclosed that they did not receive any grant during conduction or writing of this study.

References

• 1. Nikkilä HV, Müller K, Ahokas A, Rimón R, Andersson LC. Increased frequency of activated lymphocytes in the cerebrospinal fluid of patients with acute schizophrenia. Schizophr Res 2001;49:99-105.
• 2. Potvin S, Stip E, Sepehry AA, Gendron A, Bah R, Kouassi E, et al. Inflammatory cytokine alterations in schizophrenia: a systematic quantitative review. Biol Psychiatry 2008;63:801-8.
• 3. Müller N. The role of anti-inflammatory treatment in psychiatric disorders. Psychiatr Danub 2013;25:292-8.
• 4. Benros M, Nielsen P, Nordentoft M, Eaton W, Dalton S, Mortensen P. Autoimmune diseases and severe infections as risk factors for schizophrenia: a 30-year population-based register study. Am J Psychiatry 2011;168:1303-10.
• 5. Wium-Andersen MK, Orsted DD, Nordestgaard BG. Elevated C-reactive protein associated with late- and very-late- onset schizophrenia in the general population: a prospective study. Schizophrenia Bull 2014;40:1117-27.
• 6. Müller N, Schwarz MJ. Immune system and schizophrenia. Curr Immunol Rev 2010;6:213-20.
• 7. Kuyumcu ME, Yesil Y, Ozturk ZA, Kizilarslanoglu C, Etgül S, Halil M, et al. The evaluation of neutrophil-lymphocyte ratio in Alzheimer’s disease. Dement Geriatr Cogn Disord 2012;34:69-74.
• 8. Balta S, Demirkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int 2013;17:668-9.
• 9. Kopuz A, Turan V, Ozcan A, Kopuz Y, Toz E, Kurt S. A novel marker for the assessment of the treatment result in pelvic inflammatory disease. Minerva Ginecol 2016;68:117-23.
• 10. Akıl E, Bulut A, Kaplan I, Özdemir HH, Arslan D, Aluçlu MU. The increase of carcinoembryonic antigen (CEA), high-sensitivity C-reactive protein, and neutrophil/lymphocyte ratio in Parkinson's disease. Neurol Sci 2015;36:423-8.
• 11. Rembach A, Watt AD, Wilson WJ, Rainey-Smith S, Ellis KA, Rowe CC, et al. An increased neutrophil-lymphocyte ratio in Alzheimer's disease is a function of age and is weakly correlated with neocortical amyloid accumulation. J Neuroimmunol 2014;273:65-71.
• 12. Kalelioglu T, Akkus M, Karamustafalioglu N, Genc A, Genc ES, Cansiz A, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder. Psychiatry Res 2015;228:925-7.
• 13. Gündüz N, Timur Ö, Erzincan E, Turgut C, Turan H, Akbey ZY. Evaluation of mean platelet volume, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and red cell distribution width in patients with diagnosis of major depressive disorder. Med Med J 2017;32:230-7.
• 14. Özdin S, Sarisoy G, Böke Ö. A comparison of the neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios in schizophrenia and bipolar disorder patients - a retrospective file review. Nord J Psychiatry 2017;71:509-12.
• 15. Aykut DS, Arslan FC, Karagüzel EÖ, Aral G, Karakullukçu S. The relationship between neutrophil-lymphocyte, platelet–lymphocyte ratio and cognitive functions in bipolar disorder. Nord J Psychiatry 2018;72:119-23.
• 16. Manu P, Correll CU, Wampers M, Mitchell AJ, Probst M, Vancampfort D, et al. Markers of inflammation in schizophrenia: association vs. causation. World Psychiatry 2014;13:189-92.
• 17. Semiz M, Yildirim O, Canan F, Demir S, Hasbek E, Tuman TC, et al. Elevated neutrophil/lymphocyte ratio in patients with schizophrenia. Psychiatr Danub 2014;26:220-5.
• 18. Kulaksizoglu B, Kulaksizoglu S. Relationship between neutrophil/lymphocyte ratio with oxidative stress and psychopathology in patients with schizophrenia. Neuropsychiatr Dis Treat 2016;12:1999-2005.
• 19. Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int 2013;17:391-6.
• 20. Keshtkar M, Ghanizadeh A, Firoozabadi A. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for the treatment of major depressive disorder, a randomized controlled clinical trial. J ECT 2011;27:310-4.
• 21. Jahangard, L, Haghighi M, Bigdelou G, Bajoghli H, Brand S. Comparing efficacy of ECT with and without concurrent sodium valproate therapy in manic patients. J ECT 2012;28:118-23.
• 22. Kruse JL, Congdon E, Olmstead R, Njau S, Breen EC, Narr KL, et al. Inflammation and improvement of depression following electroconvulsive therapy in treatment-resistant depression. J Clin Psychiatry 2018;79:17m11597.
• 23. Asoğlu M, Göbelek M, Karka İ, Pirinççioglu F, Çelik H, Ay H, et al. Effect of electroconvulsive therapy on hematological parameters. Bezmialem Science 2018;6:130-3.
• 24. Fluitman SB, Heijnen CJ, Denys DA, Nolen WA, Balk FJ, Westenberg HG. Electroconvulsive therapy has acute immunological and neuroendocrine effects in patients with major depressive disorder. J Affect Disord 2011;131:388-92.
• 25. Chaturvedi S, Chadda RK, Rusia U, Jain N. Effect of electroconvulsive therapy on hematological parameters. Psychiatry Res 2001;104:265-8.
• 26. Khandaker GM, Cousins L, Deakin J, Lennox BR, Yolken R, Jones PB. Inflammation and immunity in schizophrenia: implications for pathophysiology and treatment. Lancet Psychiatry. 2015;2:258-70.
• 27. Patel PS, Buras ED, Balasubramanyam A. The role of the immune system in obesity and insulin resistance. J Obes 2013;2013:616193.
• 28. Rodríguez-Hernández H, Simental-Mendía LE, Rodríguez-Ramírez G, Reyes Romero MA. Obesity and inflammation: epidemiology, risk factors andmarkers of inflammation. Int J Endocrinol 2013;2013:678159.
• 29. Balistreri CR, Caruso C, Candore G. The role of adipose tissue and adipokines in obesity-related inflammatory diseases. Mediators Inflamm 2010;2010:802078.
• 30. Fernandes B, Steiner J, Bernstein HG, Dodd S, Pasco JA, Dean OM, et al. C-reactive protein is increased in schizophrenia but is not altered by antipsychotics: meta-analysis and implications. Mol Psychiatry 2016;21:554-64.
• 31. Kweon OJ, Lee MK, Kim HJ, Chung JW, Choi SH, Kim HR. Neutropenia and neutrophil-tolymphocyte ratio in a healthy Korean population: race and sex should be considered. Int J Lab Hematol 2016;38:308-18.
• 32. Çakır U, Tuman TC, Yıldırım O. Increased neutrophil/lymphoctye ratio in patients with bipolar disorder: a preliminary study. Psychiatr Danub 2015;27:180-4.
• 33. Kayhan F, Gündüz S, Ersoy SA, Kandeger A, Annagür BB. Relationships of neutrophil–lymphocyte andplatelet–lymphocyte ratios with the severity of major depression. Psychiatry Res 2017;247:332-5.
• 34. Mayda H, Ahsen A, Bagcıoglu E, Öztürk A, Bahçeci B, Soyuçok E, et al. Effect of increased neutrophil-to-lymphocyte ratio (NLR) and decreased mean platelet volume (MPV) values on inflammation in acute mania. Arch Neuropsychiatry 2016;53:317-20.
• 35. Canan F, Kürklü N, Geçici Ö, Kuloglu M. The effect of electroconvulsive therapy on neutrophyl/lymphocyte ratio. JMOOD 2016;6:1-6.
• 36. Miller BJ, Buckley P, Seabolt W, Mellor A, Kirkpatrick B. Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry 2011;70:663-71.
• 37. de Witte L, Tomasik J, Schwarz E, Guest PC, Rahmoune H, Kahn RS, et al. Cytokine alterations in first-episode schizophrenia patients before and after antipsychotic treatment. Schizophr Res 2014;154:23-9.
• 38. Wysokinski A, Szczepocka E. Platelet parameters (PLT, MPV, P-LCR) in patients with schizophrenia, unipolar depression and bipolar disorder. Psychiatry Res 2016;237:238-45.
• 39. Lee J, Powell V, Remington G. Mean platelet volume in schizophrenia unaltered after 1 year of clozapine exposure. Schizophr Res 2014;157:134-6.
• 40. Ma J, Dou Y, Zhang H, Thijssen SW, Kuntsevich V, Ouellet G, et al. Correlation between inflammatory biomarkers and red blood cell life span in chronic hemodialysis patients. Blood Purif 2017;43:200-5.
• 41. Ayyildiz H, Karabulut N, Kalayci M. Relationship between red blood cell distribution width and schizophrenia. Int J Med Biochem 2018;1:15-9.
• 42. Asoglu M, Aslan M, Canbolat O, Imre O, Savik E, Kivrak Y, et al. Red cell distribution width, mean platelet volume and vitamin B12 levels in patients with schizophrenia: an observational study. Int J Clin Exp Med 2016;9:16629-36.
• 43. Huang YL, Hu ZD. Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in intensive care unit admitted patients with acute myocardial infarction. Ann Transl Med 2016;4:190.
• 44. Balõtšev R, Haring L, Koido K, Leping V, Kriisa K, Zilmer M, et al. Antipsychotic treatment is associated with inflammatory and metabolic biomarkers alterations among first-episode psychosis patients: A 7-month follow-up study. Early Interv Psychiatry 2019;13:101-9.
• 45. Maes M, Bocchio CL, Bignotti S, Battisa TG, Pioli R, Boin F, et al. Effects of atypical antipsychotics on the inflammatory response system in schizophrenic patients resistant to treatment with typical neuroleptics. Eur Neuropsychopharmacol 2000;10:119-24.
• 46. Upthegrove R, Manzanares-Teson N, Barnes NM. Cytokine function in medication-naive first episode psychosis: a systematic review and meta-analysis. Schizophr Res 2014;155:101-8.
• 47. Semiz M, Yucel H, Kavakci O, Yildirim O, Zorlu A, Yilmaz MB, et al. Atypical antipsychotic use is an independent predictor for the increased mean platelet volume in patients with schizophrenia: a preliminary study. J Res Med Sci 2013;18:561-6.
• 48. Celebioglu B, Yigit H, Rezaki M, Ercelen O, Kayatekin S. Anesthesia in electroconvulsive therapy. Ann Saudi Med 1999;19:144-6.
• 49. Zhou R, Yang Z, Tang X, Tan Y, Wu X, Liu F. Propofol protects against focal cerebral ıschemia via inhibition of microglia-mediated proinflammatory cytokines in a rat model of experimental stroke. PLoS ONE 2013;8:e82729.
• 50. Samir A, Gandreti N, Madhere M, Khan A, Brown M, Loomba V. Anti-inflammatory effects of propofol during cardiopulmonary bypass: A pilot study. Ann Card Anaesth 2015;18:495-501.
• 51. Markovic-Bozic J, Karpe B, Potocnik I, Jerin A, Vranic A, Novak-Jankovic V. Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy. BMC Anesthesiol 2016;16:18.