The relationship of neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and CRP with psychopathology in adolescents with first attack psychosis and prodrome psychosis

Objective: Schizophrenia spectrum disorders are neurodevelopmental psychiatric disorders with severe impairments in cognitive functions and social relationships, as well as psychotic symptoms that usually appear during adolescence or young adulthood. There is increasing interest in the immune hypothesis of schizophrenia. Since the physiological response of leukocytes to stressful situations such as inflammation causes an increase in the number of neutrophils and a decrease in the number of lymphocytes, and the Neutrophil/Lymphocyte ratio (NLR) can be easily calculated, it has been frequently used as an indicator of inflammation recently. In this study, NLR, MLR and CRP, which is an inexpensive and reproducible test, were determined as clinical inflammation markers in patients with first episode psychosis and prodrome psychosis ,between the ages of 12-23, followed by Dokuz Eylul University Hospital Child and Adolescent Psychiatry and Adult Psychiatry Units. It is aimed to test its usability in adolescents with psychosis and to show the correlation between symptom severity and clinical inflammation. Matherial and Methods : This study consists of a total of 143 cases, including the cases with first episode psychosis ,prodrome psychosis and the healthy control group,between the ages of 12-23, who applied to the Child and Adolescent Psychiatry and Adult Psychiatry Units of Dokuz Eylul University Hospital. The necessary data for the study were obtained by retrospectively scanning the files of the patients.The diagnoses of the cases were made by the assigned clinicians according to the DSM-IV (pre-2013) and DSM-5 diagnostic criteria, and the diagnosis of the cases in the prodrome psychosis group was assesed with ERIraos (Early Recognition Inventory; ERIraos-Turkish Version). Functioning was evaluated with The Children's Global Assessment Scale (CGAS) and the clinical severity of the disease was evaluated with the Clinical Global Impression - Severity (CGI-S) and Positive and Negative Symptom Scale (PANSS). Results : NLR, PLR and MLR values of first episode psychosis cases were statistically significantly lower than healthy controls (p=0.027 ;p=0.008 ;p=0.005).The neutrophil value of the first episode psychosis group was statistically significantly lower than the prodrome psychosis group (p=0.025). The CGAS value of the first episode psychosis group was 32 (26-42.75), the CGAS value of the prodrome psychosis group was 67 (59-72), and the CGAS value of the healthy control group was 81.5 (78-85). The lower CGAS value of the first episode psychosis group compared to the prodrome and healthy control groups was statistically significant (p=0.000).When the CGI-S scores were compared, a significant difference was found between the groups (p=0.000).A statistically moderately significant negative correlation was found between CGI-S scores, platelet value and monocytes (p=0.007; p=0.009). Conclusion: Our study revealed that there are differences in immunological processes and values between the first episode psychosis and prodrome psychosis and healthy controls. Although there are studies investigating immunity in schizophrenia patients with adult samples in the literature, the number of studies conducted in the adolescents and the prodrome psychosis is quite limited. According to the results of our study, immune suppression is observed in cases with first episode psychosis compared to healthy controls. This finding shows us that these hematological parameters can be used in the evaluation of the disease in the adolescent group. In our study, parameters that were negatively correlated with disease severity were found.These parameters can be used to monitor disease severity and monitor treatment response. Keywords: First Episode Psychosis; Schizophrenia; ProdromePsychosis; Neutrophil/ Lymphocyte Ratio ; Platelet/Lymphocyte Ratio; Monosit/Lymphocyte Ratio; CRP; Adolescent;UHR