İlk atak psikoz hastalarında tedavi başlangıcından 6 ay sonraki immunolojik parametrelerin incelenmesi
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Tarih
2020
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
GİRİŞ: Şizofreni ve ilişkili bozukluklar; bilişsel, davranışsal ve emosyonel disfonksiyon ile kendini gösteren, sosyal ve mesleki alanlarda önemli kayıplarla seyreden psikiyatrik hastalıklardır. Buna rağmen hastalığın altında yatan mekanizmalarla ilgili bilgilerimiz kısıtlıdır. Güncel çalışmalar immünolojik süreçlerin hastalığın oluşumda önemli rol oynadığını göstermektedir. AMAÇ: Bu çalışmanın amacı; ilk atak psikoz hastalarının tedavinin başlangıcından itibaren izleme alınması, hastaların immünolojik belirteçlerinin süreç içinde nasıl bir değişim gösterdiğinin belirlenmesi ve bu değişimin semptom şiddeti ile ilişkisinin araştırılmasıdır. YÖNTEM: Çalışmaya daha önce ''İlk Atak Psikoz Hastalarında İmmünolojik Parametrelerin İncelenmesi'' isimli çalışmaya katılmış olan ve bu çalışmaya da katılmaya gönüllü olan hastalar alınmıştır. Tanı değişimini gözlemleyebilmek için, hastalar ilk çalışmaya alındıktan en az 6 ay sonra ikinci çalışmaya davet edilmişlerdir. İzlem ileriye dönük olarak gerçekleştirilmiştir. Semptom şiddetinin belirlenmesi için Pozitif ve Negatif Semptom Ölçeği (PANSS) ve Kısa Psikiyatrik Değerlendirme Ölçeği (BPRS) uygulanmıştır. Görüşme sonrasında immünolojik parametreler için hastalardan kan örnekleri alınmıştır. İmmünolojik belirteçlerin zaman içindeki değişiminin değerlendirilmesi için; ikinci çalışmaya katılan hastaların kan sonuçları, birinci çalışmaya katılan hem hastaların hem sağlıklı kontrollerin kan sonuçları ile karşılaştırılmıştır. Ek olarak hastaların bu çalışmadaki semptom şiddeti ile hem bu çalışmadaki hem de ilk çalışmadaki kan sonuçlarının ilişkisi incelenmiştir. BULGULAR: Birinci çalışmaya katılan 32 hastadan 20 tanesi bu çalışmaya dahil olmuştur. Bu çalışmaya katılan hastalar ile birinci çalışmaya katılan hastalar arasında sosyodemografik özellikler açısından anlamlı farklılık bulunmamıştır. Birinci ve ikinci zaman arasındaki ortalama süre 374,25 gündür. Hastaların hem birinci zamandaki (T1) hem ikinci zamandaki (T2) lökosit, nötrofil, monosit, kompleman 3 ve kompleman 4 düzeyleri ile nötrofil/lenfosit oranları sağlıklı kontrollere göre anlamlı şekilde yüksektir. Otoantikorlar açısından ise iki grup arasında anlamlı farklılık bulunmamıştır. İzlemin sonunda hastaların PANSS pozitif, PANSS genel, PANSS total ve BPRS skorlarında anlamlı azalma olduğu görülmüştür. Korelasyon analizine göre hastaların T1 zamanındaki immunglobulin E (IgE) düzeyleri ile T2 zamanındaki PANSS genel, PANSS total ve BPRS skorları arasında anlamlı ilişki olduğu bulunmuştur. SONUÇ: Bu çalışmanın sonuçlarına göre; ilk atak psikoz hastalarında artmış bir inflamatuar etkinliğin bulunduğu saptanmıştır. Yaklaşık bir yıllık izlem süresinin sonunda hastaların semptomlarındaki gerilemeye rağmen bu inflamasyonun devam etmektedir. Otoimmunite açısından ise anlamlı bir farklılık bulunmamıştır. Bu bulgular hastalığın patogenezine yönelik planlanacak olan daha geniş örneklemli çalışmalar için yol gösterici olabilir.
INTRODUCTION: Schizophrenia and related disorders are psychiatric diseases that manifest with cognitive, behavioral and emotional dysfunction and progress with significant losses in social and professional fields. However, our knowledge about the mechanisms underlying the disease is limited. Current studies show that immunological processes play an important role in the occurrence of the disease. AIM: The purpose of this study is; to follow up the first episode psychosis (FEP) patients from the beginning of the treatment, to determine how the immunological markers of the patients change in the process and to investigate the relationship of this change with the severity of the symptoms. METHOD: Patients who previously participated in the study named "Investigation of Immunological Parameters in The First Episode Psychosis Patients" and who also volunteered to participate in this study were included. In order to observe the change in diagnosis, patients were invited to the second study at least 6 months after they were included in the first study. The follow-up was carried out prospectively. Positive and Negative Symptom Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) were applied to determine symptom severity. After the interview, blood samples were taken from the patients for immunological parameters. To evaluate the change of immunological markers over time; the blood results of the patients who participated in the second study were compared with those of both patients and healthy controls who participated in the first study. In addition, the relationship between patients' symptom severity in this study and blood results in both this study and the first study were examined. RESULTS: 20 of 32 patients who participated in the first study were included in this study. No significant difference was found between the patients who participated in this study and those who participated in the first study in terms of sociodemographic characteristics. The average time between the first and second assessment time is 374.25 days. The leukocyte, neutrophil, monocyte, complement 3 and complement 4 levels and neutrophil / lymphocyte ratios of patients in both first time (T1) and second time (T2) are significantly higher than healthy controls. In terms of autoantibodies, there was no significant difference between the two groups. At the end of the follow-up, there was a significant decrease in PANSS positive, PANSS global, PANSS total and BPRS scores. According to the correlation analysis, it was found that there was a significant relationship between the immunoglobulin E (IgE) levels of the patients at T1 time and PANSS global, PANSS total and BPRS scores at T2 time. CONCLUSION: According to the results of this study; increased inflammatory activity was found in the first episode psychosis patients. Despite the decrease in the symptoms of the patients at the end of the follow-up period of approximately one year, this inflammatory activity persisted. There was no significant difference in terms of autoimmunity. These findings may be a guide for larger sample studies that will be planned to investigate the pathogenesis of the disease.
INTRODUCTION: Schizophrenia and related disorders are psychiatric diseases that manifest with cognitive, behavioral and emotional dysfunction and progress with significant losses in social and professional fields. However, our knowledge about the mechanisms underlying the disease is limited. Current studies show that immunological processes play an important role in the occurrence of the disease. AIM: The purpose of this study is; to follow up the first episode psychosis (FEP) patients from the beginning of the treatment, to determine how the immunological markers of the patients change in the process and to investigate the relationship of this change with the severity of the symptoms. METHOD: Patients who previously participated in the study named "Investigation of Immunological Parameters in The First Episode Psychosis Patients" and who also volunteered to participate in this study were included. In order to observe the change in diagnosis, patients were invited to the second study at least 6 months after they were included in the first study. The follow-up was carried out prospectively. Positive and Negative Symptom Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) were applied to determine symptom severity. After the interview, blood samples were taken from the patients for immunological parameters. To evaluate the change of immunological markers over time; the blood results of the patients who participated in the second study were compared with those of both patients and healthy controls who participated in the first study. In addition, the relationship between patients' symptom severity in this study and blood results in both this study and the first study were examined. RESULTS: 20 of 32 patients who participated in the first study were included in this study. No significant difference was found between the patients who participated in this study and those who participated in the first study in terms of sociodemographic characteristics. The average time between the first and second assessment time is 374.25 days. The leukocyte, neutrophil, monocyte, complement 3 and complement 4 levels and neutrophil / lymphocyte ratios of patients in both first time (T1) and second time (T2) are significantly higher than healthy controls. In terms of autoantibodies, there was no significant difference between the two groups. At the end of the follow-up, there was a significant decrease in PANSS positive, PANSS global, PANSS total and BPRS scores. According to the correlation analysis, it was found that there was a significant relationship between the immunoglobulin E (IgE) levels of the patients at T1 time and PANSS global, PANSS total and BPRS scores at T2 time. CONCLUSION: According to the results of this study; increased inflammatory activity was found in the first episode psychosis patients. Despite the decrease in the symptoms of the patients at the end of the follow-up period of approximately one year, this inflammatory activity persisted. There was no significant difference in terms of autoimmunity. These findings may be a guide for larger sample studies that will be planned to investigate the pathogenesis of the disease.
Açıklama
Anahtar Kelimeler
İlk Atak Psikoz, Şizofreni, İnflamasyon, Otoimmunite, First-episode Psychosis, Schizophrenia, Inflammation, Autoimmunity
