Abstract
Schizophrenia is a complex mental disorder whose course varies with periods of deterioration and symptomatic improvement without diagnosis and treatment specific for the disease. So far, it has not been possible to clearly define what kinds of functional and structural changes are responsible for the onset or recurrence of acute psychotic decompensation in the course of schizophrenia, and to what extent personality disorders may precede the appearance of the appropriate symptoms. The work combines magnetic resonance spectroscopy imaging with clinical evaluation and laboratory tests to determine the likely pathway of schizophrenia development by identifying peripheral cerebral biomarkers compared to personality disorders. The relationship between the level of metabolites in the brain, the clinical status of patients according to International Statistical Classification of Diseases and Related Health Problems, 10th Revision ICD-10, duration of untreated psychosis (DUP), and biochemical indices related to redox balance (malondialdehyde), the efficiency of antioxidant systems (FRAP), and bioenergetic metabolism of mitochondria, were investigated. There was a reduction in the level of brain N-acetyl-aspartate and glutamate in the anterior cingulate gyrus of patients with schisophrenia compared to the other groups that seems more to reflect a biological etiopathological factor of psychosis. Decreased activity of brain metabolites correlated with increased peripheral oxidative stress (increased malondialdehyde MDA) associated with decreased efficiency of antioxidant systems (FRAP) and the breakdown of clinical symptoms in patients with schizophrenia in the course of psychotic decompensation compared to other groups. The period of untreated psychosis correlated negatively with glucose value in the brain of people with schizophrenia, and positively with choline level. The demonstrated differences between two psychiatric units, such as schizophrenia and personality disorders in relation to healthy people, may be used to improve the diagnosis and prognosis of schizophrenia compared to other heterogenous psychopathology in the future. The collapse of clinical symptoms of patients with schizophrenia in the course of psychotic decompensation may be associated with the occurrence of specific schizotypes, the determination of which is possible by determining common relationships between changes in metabolic activity of particular brain structures and peripheral parameters, which may be an important biological etiopathological factor of psychosis. Markers of peripheral redox imbalance associated with disturbed bioenergy metabolism in the brain may provide specific biological factors of psychosis however, they need to be confirmed in further studies.
Highlights
Schizophrenia is a chronic, debilitating neurodegenerative disease, which is characterized by, among others, behavioral changes and the occurrence of productive symptoms, presenting a wide spectrum of clinical syndromes, significant inter-individual differences, and biological heterogeneity at the level of analyzed patient groups [1,2]
This study was conducted on 111 young adults aged 22–29 years. 40 patients (18 women; with mean age ± standard deviation: 22.68 ± 7.39 and 22 men: 22 ± 55) with diagnoses of paranoid schizophrenia in the course of psychotic decompensation according to the ICD-10 classification (F20); 41 patients with diagnoses of personality disorders according to ICD-10 (F60) and matched with age 30 healthy control group were recruited to the study
To the best of our knowledge, this study is the first to suggest severity-specific changes in the assessment of glutamate, N-acetyl-aspartate, and other anterior cingulate cortex (ACC) metabolites in the brain associated with the clinical status, untreated psychosis, and redox imbalance related to the severity of the psychotic process underlying psychotic decompensation in schizophrenia in comparison to personality disorders and healthy persons
Summary
Schizophrenia is a chronic, debilitating neurodegenerative disease, which is characterized by, among others, behavioral changes and the occurrence of productive symptoms, presenting a wide spectrum of clinical syndromes, significant inter-individual differences, and biological heterogeneity at the level of analyzed patient groups [1,2]. More than 70% of patients who develop acute symptoms of psychotic decompensation in the course of schizophrenia for the first time experience significant symptomatic improvement. The negative symptoms of schizophrenia associated with withdrawal from life activities, difficulty in building and maintaining interpersonal relationships and changes in experiencing emotions are difficult to treat. Productive symptoms, such as hallucinations characteristic for schizophrenia, formal disorganization of thinking or disturbance of its content in the form of delusions of exposure and influence, persecution, respond to an antipsychotic treatment to a greater extent
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