Predictive value of white blood cell counts, ratios and C-reactive protein in schizophrenia spectrum disorder
[eng] INTRODUCTION: Schizophrenia is a severe psychiatric disorder that affects approximately 0.5-1% of the population. It typically follows a chronic course characterized by multiple relapses, with up to 30% of patients experiencing treatment-resistant schizophrenia (TRS) and facing a reduced life...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2025 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/223820 |
| Acceso en línea: | https://hdl.handle.net/2445/223820 http://hdl.handle.net/10803/695532 |
| Access Level: | acceso abierto |
| Palabra clave: | Psiquiatria Immunologia Psicofarmacologia Mortalitat Psychiatry Immunology Psychopharmacology Mortality |
| Sumario: | [eng] INTRODUCTION: Schizophrenia is a severe psychiatric disorder that affects approximately 0.5-1% of the population. It typically follows a chronic course characterized by multiple relapses, with up to 30% of patients experiencing treatment-resistant schizophrenia (TRS) and facing a reduced life expectancy. The causes of schizophrenia are complex and involve a combination of genetic and environmental risk factors, leading to various hypotheses about its origins. One prominent theory is the immune hypothesis, which suggests that immune system dysfunction plays a critical role in the disorder's etiopathophysiology. While numerous biomarkers have been investigated for their potential to indicate this dysfunction, the predictive value of cost-effective markers, such as white blood cell (WBC) counts, ratios, and C-reactive protein (CRP), has been largely understudied. HYPOTHESES: The main hypothesis of this thesis is that immune biomarkers, such as WBC counts, their ratios, and CRP levels, can predict clinical outcomes in patients with schizophrenia and other psychotic disorders across different phases of the illness, including treatment response, relapse, readmissions, and mortality. OBJECTIVES: To investigate the previously stated hypotheses, five specific objectives are outlined, with nine articles addressing them. The first objective (Articles I and II) focuses on the early stages of the disease, evaluating the relationship between the neutrophil-to-lymphocyte ratio (NLR) and treatment response over three years in patients with a First Episode of Psychosis (FEP), and assessing whether WBC counts and ratios in stable patients after a First Episode of Schizophrenia (FES) can predict relapse. The second objective (Articles III and IV) examines acutely hospitalized patients with established psychotic disorders, exploring how WBC counts, ratios, and CRP levels can predict functional response, as measured by Global Assessment of Functioning (GAF) scores. The third objective (Article V) focuses on TRS, investigating whether WBC count ratios can predict response to clozapine initiation, assessed by Positive and Negative Syndrome Scale (PANSS) SUMMARY scores. The fourth objective (Article VI) looks at long-term outcomes, exploring the association between WBC counts, ratios, and CRP levels in FEP patients, and their relationship to mortality, treatment response, and readmissions, using register-based proxies. The fifth objective (Articles VII, VIII, and IX) investigates the relationship between WBC count ratios and other immune markers in acutely hospitalized psychiatric patients, and examines how substance use (such as cannabis, opioids, or cocaine) impacts these markers. |
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