Association of symptom severity and cerebrospinal fluid alterations in recent onset psychosis in schizophrenia-spectrum disorders – An individual patient data meta-analysis

Campana, Mattia ; Yakimov, Vladislav ; Moussiopoulou, Joanna ; Maurus, Isabel ; Löhrs, Lisa; Raabe, Florian; Jäger, Iris; Mortazavi, Matin ; Benros, Michael E.; Jeppesen, Rose; Meyer zu Hörste, Gerd; Heming, Michael; Giné-Servén, Eloi; Labad, Javier; Boix, Ester; Lennox, Belinda; Yeeles, Ksenija; Steiner, Johann; Meyer-Lotz, Gabriela; Dobrowolny, Henrik; Malchow, Berend; Hansen, Niels; Falkai, Peter; Siafis, Spyridon; Leucht, Stefan; Halstead, Sean; Warren, Nicola; Siskind, Dan; Strube, Wolfgang; Hasan, Alkomiet und Wagner, Elias (2024): Association of symptom severity and cerebrospinal fluid alterations in recent onset psychosis in schizophrenia-spectrum disorders – An individual patient data meta-analysis. In: Brain, Behavior, and Immunity, Bd. 119: S. 353-362

Abstract

Neuroinflammation and blood-cerebrospinal fluid barrier (BCB) disruption could be key elements in schizophrenia-spectrum disorderś(SSDs) etiology and symptom modulation. We present the largest two-stage individual patient data (IPD) meta-analysis, investigating the association of BCB disruption and cerebrospinal fluid (CSF) alterations with symptom severity in first-episode psychosis (FEP) and recent onset psychotic disorder (ROP) individuals, with a focus on sex-related differences. Data was collected from PubMed and EMBASE databases. FEP, ROP and high-risk syndromes for psychosis IPD were included if routine basic CSF-diagnostics were reported. Risk of bias of the included studies was evaluated. Random-effects meta-analyses and mixed-effects linear regression models were employed to assess the impact of BCB alterations on symptom severity. Published (6 studies) and unpublished IPD from n = 531 individuals was included in the analyses. CSF was altered in 38.8 % of individuals. No significant differences in symptom severity were found between individuals with and without CSF alterations (SMD = -0.17, 95 %CI −0.55–0.22, p = 0.341). However, males with elevated CSF/serum albumin ratios or any CSF alteration had significantly higher positive symptom scores than those without alterations (SMD = 0.34, 95 %CI 0.05–0.64, p = 0.037 and SMD = 0.29, 95 %CI 0.17–0.41p = 0.005, respectively). Mixed-effects and simple regression models showed no association (p > 0.1) between CSF parameters and symptomatic outcomes. No interaction between sex and CSF parameters was found (p > 0.1). BCB disruption appears highly prevalent in early psychosis and could be involved in positive symptomś severity in males, indicating potential difficult-to-treat states. This work highlights the need for considering BCB breakdown and sex-related differences in SSDs clinical trials and treatment strategies.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin > Klinikum der LMU München > Klinik und Poliklink für Psychiatrie und Psychotherapie
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 08891591
• Sprache: Englisch