Abstract
Multiple lines of evidence indicate that immunological and inflammatory alterations contribute at least in a subgroup to the pathophysiology of schizophrenia. In this retrospective chart review, we investigated whether clinical factors contribute to altered cerebrospinal fluid (CSF) findings in schizophrenia-spectrum disorders. Clinical data from electronic medical records of patients with psychotic disorders (ICD-10: F20-F29) who received routine CSF diagnostics at the Department of Psychiatry and Psychotherapy, LMU Munich, Germany, were included. Chi² tests for dichotomous outcomes and independent t tests for continuous outcomes were used to compare differences between groups. A total of 331 patients were included in the analyses (43.2% female and 56.8% male). The mean age was 37.67 years (±15.58). The mean duration of illness was 71.96 months (±102.59). In all, 40% (128/320) were first-episode psychosis (FEP) patients and 60% (192/320) were multi-episode psychosis (MEP) patients. Elevated CSF protein levels were found in 19.8% and elevated CSF/serum albumin ratios (QAlb) in 29.4% of the cases. Pleocytosis was found in 6.1% of patients. MEP patients showed significantly higher mean QAlb compared with FEP patients (t(304.57) = −2.75, p = 0.006), which did not remain significant after correcting for age. QAlb elevation occurred more frequently in men (X2(1) = 14.76, p = <0.001). For treatment resistance, family history, and cMRI alterations, no significant differences in CSF-related outcomes were detected. Our work extends other retrospective cohorts confirming a relevant degree of CSF alterations in schizophrenia-spectrum disorders and shows the difficulty to relate these alterations to clinical and disease course trajectories. More research is needed to develop treatment response predictors from CSF analyses.
Highlights
Schizophrenia is a severe neuropsychiatric disorder with onset mostly in late adolescence to early adulthood [1] and showing a relapsing disease course in approximately two-thirds of the patients and a chronic-progressive course in many of the cases that often leads to a relevant functional and cognitive impairment [2]
We extracted the age at the time of the lumbar puncture, and categorical data, such as gender, illegal substance abuse, alcohol, cannabis, and nicotine/tobacco abuse according to ICD-10, diagnosed rheumatic, infectious, or central nervous system (CNS) disease, type II diabetes, and thyroid disease
We defined whether patients were patients with FEP or with recurrent/ multi-episode psychosis (MEP) disease course
Summary
Schizophrenia is a severe neuropsychiatric disorder with onset mostly in late adolescence to early adulthood [1] and showing a relapsing disease course in approximately two-thirds of the patients and a chronic-progressive course in many of the cases that often leads to a relevant functional and cognitive impairment [2]. This body of evidence suggests that in a subgroup of patients with schizophrenia immunological alterations can be detected in transfer of oligoclonal bands from the serum to the CSF through an abnormal blood-brain barrier and does not indicate intrathecal IgG synthesis.
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