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C-reactive protein is increased in schizophrenia but is not altered by antipsychotics : meta-analysis and implications

Fernandes, B.S., Steiner, J., Bernstein, H-G., Dodd, S., Pasco, J.A., Dean, O.M., Nardin, P., Gonçalves, C.A. and Berk, M. 2016, C-reactive protein is increased in schizophrenia but is not altered by antipsychotics : meta-analysis and implications, Molecular psychiatry, vol. 21, pp. 554-564, doi: 10.1038/mp.2015.87.

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Title C-reactive protein is increased in schizophrenia but is not altered by antipsychotics : meta-analysis and implications
Author(s) Fernandes, B.S.
Steiner, J.
Bernstein, H-G.
Dodd, S.ORCID iD for Dodd, S. orcid.org/0000-0002-7918-4636
Pasco, J.A.ORCID iD for Pasco, J.A. orcid.org/0000-0002-8968-4714
Dean, O.M.ORCID iD for Dean, O.M. orcid.org/0000-0002-2776-3935
Nardin, P.
Gonçalves, C.A.
Berk, M.ORCID iD for Berk, M. orcid.org/0000-0002-5554-6946
Journal name Molecular psychiatry
Volume number 21
Start page 554
End page 564
Total pages 11
Publisher Nature Publishing Group
Place of publication London, Eng.
Publication date 2016
ISSN 1476-5578
Summary The inflammatory hypothesis of schizophrenia (SZ) posits that inflammatory processes and neural-immune interactions are involved in its pathogenesis, and may underpin some of its neurobiological correlates. SZ is the psychiatric disorder causing the most severe burden of illness, not just owing to its psychiatric impairment, but also owing to its significant medical comorbidity. C-reactive protein (CRP) is a commonly used biomarker of systemic inflammation worldwide. There are some conflicting results regarding the behaviour of CRP in SZ. The aims of this study were to verify whether peripheral CRP levels are indeed increased in SZ, whether different classes of antipsychotics divergently modulate CRP levels and whether its levels are correlated with positive and negative symptomatology. With that in mind, we performed a meta-analysis of all cross-sectional studies of serum and plasma CRP levels in SZ compared to healthy subjects. In addition, we evaluated longitudinal studies on CRP levels before and after antipsychotic use. Our meta-analyses of CRP in SZ included a total of 26 cross-sectional or longitudinal studies comprising 85 000 participants. CRP levels were moderately increased in persons with SZ regardless of the use of antipsychotics and did not change between the first episode of psychosis and with progression of SZ (g=0.66, 95% confidence interval (95% CI) 0.43 to 0.88, P<0.001, 24 between-group comparisons, n=82 962). The extent of the increase in peripheral CRP levels paralleled the increase in severity of positive symptoms, but was unrelated to the severity of negative symptoms. CRP levels were also aligned with an increased body mass index. Conversely, higher age correlated with a smaller difference in CRP levels between persons with SZ and controls. Furthermore, CRP levels did not increase after initiation of antipsychotic medication notwithstanding whether these were typical or atypical antipsychotics (g=0.01, 95% CI -0.20 to 0.22, P=0.803, 8 within-group comparisons, n=713). In summary, our study provides further evidence of the inflammatory hypothesis of SZ. Whether there is a causal relationship between higher CRP levels and the development of SZ and aggravation of psychotic symptoms, or whether they are solely a marker of systemic low-grade inflammation in SZ, remains to be clarified.
Language eng
DOI 10.1038/mp.2015.87
Field of Research 110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 920299 Health and Support Services not elsewhere classified
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2016, Macmillan Publishers
Persistent URL http://hdl.handle.net/10536/DRO/DU:30074932

Document type: Journal Article
Collection: School of Medicine
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Created: Mon, 10 Aug 2015, 13:38:12 EST

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