ABSTRACT
Background: There is increasing evidence of the association between chronic low-grade inflammation and severe mental illness (SMI). The objective of our study was to assess serum cytokine levels (SCLs) at admission and discharge in a true-to-life-setting population of inpatients with major depression (MD), bipolar disorder (BD), and schizophrenia (Sz), as well as of healthy controls. Methods: We considered MD, BD, and Sz to be SMIs. We evaluated 206 inpatients [MD, N = 92; BD, N = 26; mania (Ma), N = 44; Sz, N = 44). Generalized estimating equations were used to analyze variations in SCL [interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17] at hospital admission and discharge. Results of 100 healthy controls were compared with those of SMI patients at both time points. We evaluated patients' improvement during in-hospital treatment in terms of general psychiatric symptoms, global clinical impression, functionality, and manic and depressive symptoms with validated scales. Results: In all, 68.9% of patients completed the study. Overall, SMI inpatients had higher SCL when compared with controls regardless of diagnosis. There was a significant decrease in Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity Scale (CGI-S) scores, and an increase in Global Assessment of Functioning (GAF) scores for all disorders evaluated (p < 0.001), as well as a significant decrease in HDRS-17 scores among MD inpatients (p < 0.001) and in YMRS scores among Ma inpatients (p < 0.001). IL-2 and IL-6 levels decreased significantly between admission and discharge only among MD inpatients (p = 0.002 and p = 0.03, respectively). We found no further statistically significant changes in SCL among the remaining disorders (BD, Ma, and Sz). There was no significant decrease in IFN-γ (p = 0.64), TNF-α (p = 0.87), IL-4 (p = 0.21), IL-10 (p = 0.88), and IL-17 (p = 0.71) levels in any of the evaluated diagnoses. Conclusion: MD inpatients had a decrease in IL-2 and IL-6 levels during hospitalization, which was accompanied by clinical improvement. No associations were found for the remaining SMIs (BD, Ma, and Sz).
ABSTRACT
In severe presentations, major depressive disorder (MDD), schizophrenia (SZ), and bipolar disorder (BD) can be categorized as severe mental disorders (SMD). Our aim is to evaluate structural magnetic resonance imaging and computed tomography findings in adult inpatients diagnosed with SMD and hospitalized at psychiatric wards. PubMed, Embase, PsycInfo, Cochrane Library, and Web of Science were searched up to May 27th, 2021. Articles were screened and extracted by two independent groups, with third-party raters for discrepancies. Quality of evidence was evaluated with the Newcastle-Ottawa Scale. Synthesis was made by qualitative analysis. This study was registered on PROSPERO (CRD42020171718) and followed the PRISMA protocol. 35 studies were included, of which none was considered to likely introduce bias in our analyses. Overlapping areas in MDD, SZ, and Affective Psychosis (AP) patients, that include BD and MDD with psychotic features, are presented in the inferior temporal and cingulate gyri. MDD and SZ had commonly affected areas in the inferior and middle frontal gyri, transverse temporal gyrus, insula, and hippocampus. SZ and AP had commonly affected areas in the temporal pole. Overlapping affected areas among SMD patients are reported, but the heterogeneity of studies' designs and findings are still a limitation for clinically relevant guidelines.
