Abstract
Schizophrenia and affective spectrum disorders (ASD) typically begin in adolescence or early adulthood. The pathophysiological mechanisms underlying these disorders are still not fully understood, and recent studies have suggested an involvement of dysfunctions in cardiometabolic and neuroendocrine systems at the onset of both disorders. In this context, we aimed to assess thyroid function, prolactin level, glucose metabolism, and lipid profile in drug naive adolescents, comparing patients with first episode of schizophrenia spectrum disorders (SSD) and patients with ASD. We performed a retrospective chart review from inpatients aged from ten to eighteen years, referred to Child and Adolescent Psychiatric Unit of University of Bari “Aldo Moro” over a period of 4 years, with diagnosis of SSD (n=30) or ASD (n=22), according to Diagnostic and Statistical Manual for Mental Disorders-fifth edition (DSM-5) criteria. Data on serum prolactin, glucose, insulin, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, thyroid stimulating hormone, free triiodothyronin, and free thyroxin were collected, and the insulin resistance (IR) indexes “HOMA1-IR“ and “HOMA2-IR” were calculated. The multivariable linear regression models, adjusting for potential confounding factors (age, sex, and BMI), showed HOMA1-IR (p=0.001), HOMA2-IR (p=0.002), glucose (p=0.004), insulin (p=0.004) and free thyroxin (p<0.001) values higher in the SSD group than in ASD. No others significant differences were found. Our findings suggest the need for a metabolic and endocrine screening at the onset of SSD and ASD, particularly for indexes of IR, that is a testable and treatable risk factor for cardiometabolic diseases. Further studies are required to better understand the role of endocrinological and metabolic dysfunctions at the onset of severe mental illness also considering influencing factors as age, gender, and BMI.
Highlights
Schizophrenia and bipolar spectrum disorders are considered as part of the psychosis continuum, with similar clinical features such as psychotic and mood symptoms as well as neurocognitive impairments of varying degrees [1]
Starting from the hypothesis of a co-shared vulnerability between impaired glucose tolerance and spectrum disorders (SSD), detectable in subclinical form even in patients with adolescent onset of psychosis, in our previous study we found higher level of PRL and increase in Homeostatic Model Assessment for Insulin Resistance (HOMA-insulin resistance (IR)) in a sample of drug naïve adolescents in the acute phase of first episode psychosis compared to subjects at clinical high risk of developing psychosis [36]
Patients were excluded: if they were younger than 10 years or older than 18 years; if they had an history of antipsychotics, antidepressants or mood stabilizing assumption; if medical history, physical examination, laboratory, and instrumental findings had revealed that psychopathological symptoms were substance induced or due to another medical condition; if there were any evidences of medical causes of HPRL, abnormal thyroid function and insulin resistance (IR)
Summary
Schizophrenia and bipolar spectrum disorders are considered as part of the psychosis continuum, with similar clinical features such as psychotic and mood symptoms as well as neurocognitive impairments of varying degrees [1]. Similarities and differences between neurodevelopmental trajectories in patients with early onset schizophrenia and early onset bipolar disorder have been described with regard to genetic, neurobiological, and environmental risk factors as well as premorbid developmental impairments [2,3,4]. Epidemiological studies have clarified that both disorders typically begins in adolescence or early adulthood [5, 6]. Recent studies showing dysfunctions in cardiometabolic and neuroendocrine systems, suggested that both psychotic and affective disorders may involve multiple systems at different stage of their clinical course [8, 9]
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