Interaction between the immune and metabolic systems in different stages of schizophrenia spectrum disorders
Date
2020-04-17
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Abstract
Enam kui 100 aastat on teadlased püüdnud aru saada inimese vaimsetest protsessidest ja nende kõrvalekalletest. Kogunenud teadmised on üha enam psüühiliste funktsioonide hälbeid seostanud erinevate aju virgatsainete koostoime häiritusega, mida omakorda mõjutab tugevalt üldine keha ainevahetuse ja immuunsüsteemi seisund.
Käesolev doktoritöö keskendus vereseerumist mõõdetavate põletiku ja ainevahetuslike markerite profiilide nihete uurimisele psühhootilise häirega patsientidel võrreldes kontrollgruppi kuulujatega. Psühhootilise episoodi korral väheneb olulisel määral inimese võimekus adekvaatselt tajuda ümbritsevat maailma, analüüsida enda tundeid, mõtteid, käitumist ning ümbrust. Esmane psühhoosiepisood võib jääda ainsaks haigushooks, kuid enamasti haigus ägeneb ajas korduvalt ning sellisel juhul on tegemist kroonilise psühhootilise häire ehk skisofreeniaspektri häirega.
Uuringus osales 38 esmase episoodiga patsienti, kes kaasati uuringusse enne psühhoosivastase ravi alustamist ja keda jälgiti 7-kuulise perioodi jooksul. Lisaks osales 105 kroonilises haiguse faasis olevat patsienti. Kontrollgruppi kuulus kokku 185 isikut.
Tulemustest selgus, et esmase psühhoosiepisoodi korral esineb patsientide vereseerumis madalatasemelise põletiku olemasolu peegeldavate markerite tasemete tõus, mis 7-kuulise psühhoosivastase ravi toimel taandub. Samas põhjustas 7-kuuline ravi kõrvaltoimena olulise kehakaalu tõusu ning seerumist mõõdetud ainevahetuse tasakaalu kajastavate biomarkerite tasemete nihkumise ebasoodsas suunas. Kroonilise psühhootilise häire ja kestva psühhoosivastase ravi foonil ilmnevad tervikorganismi tasandil püsivad soovimatud ainevahetuslike ja põletikumarkerite tasemete tõusud, mis seonduvad kõrgenenud riskiga haigestuda ainevahetushäiretesse ja südame-veresoonkonna haigustesse.
Tulemusi on edaspidiselt võimalik kliinilises töös kasutada haiguse tõenduspõhisemal diagnoosimisel ning kasutatava psühhoosivastase ravi kõrvaltoimete avaldumise jälgimisel ja vältimisel.
For more than 100 years, scientists have been trying to understand human mental processes and their abnormalities. Accumulated knowledge has increasingly associated abnormalities in psychic function with disturbances in the interaction of various brain neurotransmitters, which in turn are strongly influenced by the general state of the body's metabolism and immune system. This thesis focused on investigating shifts in blood serum inflammatory and metabolic marker profiles in patients with psychotic disorders compared to control subjects. In a psychotic episode, a person's ability to adequately perceive the world around them, to analyze their own feelings, thoughts, behaviors, and surroundings is significantly impaired. The first psychotic episode may remain the only episode of the disease, but in most cases, the disease worsens over time, in which case it is a chronic psychotic disorder called schizophrenia or schizophrenia spectrum disorder. The study included 38 patients with first psychotic episode who were enrolled in the study before the start of antipsychotic treatment and who were followed up for a 7-month period. In addition, 105 patients in the chronic phase of the disease participated. The control group included a total of 185 subjects. The results showed that in the first episode of psychosis, elevated levels of markers reflecting the presence of low-grade inflammation occur in patients' blood serum, which is reversed by 7- months of antipsychotic treatment. However, 7-months of treatment resulted in a significant increase in body weight and an unfavorable shift in the levels of biomarkers measured in serum metabolism. Against the background of chronic psychotic disorder and ongoing antipsychotic treatment, persistent increases in the levels of metabolic and inflammatory markers associated with an increased risk of developing metabolic disorders and cardiovascular disease occur throughout the body. The results will continue to be useful in clinical work for more evidence-based diagnosis of the disease and for monitoring and preventing the occurrence of side effects of the antipsychotic treatment used.
For more than 100 years, scientists have been trying to understand human mental processes and their abnormalities. Accumulated knowledge has increasingly associated abnormalities in psychic function with disturbances in the interaction of various brain neurotransmitters, which in turn are strongly influenced by the general state of the body's metabolism and immune system. This thesis focused on investigating shifts in blood serum inflammatory and metabolic marker profiles in patients with psychotic disorders compared to control subjects. In a psychotic episode, a person's ability to adequately perceive the world around them, to analyze their own feelings, thoughts, behaviors, and surroundings is significantly impaired. The first psychotic episode may remain the only episode of the disease, but in most cases, the disease worsens over time, in which case it is a chronic psychotic disorder called schizophrenia or schizophrenia spectrum disorder. The study included 38 patients with first psychotic episode who were enrolled in the study before the start of antipsychotic treatment and who were followed up for a 7-month period. In addition, 105 patients in the chronic phase of the disease participated. The control group included a total of 185 subjects. The results showed that in the first episode of psychosis, elevated levels of markers reflecting the presence of low-grade inflammation occur in patients' blood serum, which is reversed by 7- months of antipsychotic treatment. However, 7-months of treatment resulted in a significant increase in body weight and an unfavorable shift in the levels of biomarkers measured in serum metabolism. Against the background of chronic psychotic disorder and ongoing antipsychotic treatment, persistent increases in the levels of metabolic and inflammatory markers associated with an increased risk of developing metabolic disorders and cardiovascular disease occur throughout the body. The results will continue to be useful in clinical work for more evidence-based diagnosis of the disease and for monitoring and preventing the occurrence of side effects of the antipsychotic treatment used.
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Keywords
schizophrenia, metabolic diseases, immune system, inflammation, biomarkers, psychoses, pharmacotherapy