The clinical observation of inflammation theory for schizophrenia: a 12 week interventional study

Background: Recent research highlights the neuroinflammatory basis of Schizophrenia with an intrigue into biomarkers for schizophrenia. The involvement of immunological dysfunction in schizophrenic patients with a blunted type 1 (i.e., IL-2, gamma interferon, IL-12 and TNF-β) and an increased type 2 cytokine pattern (i.e., IL-4, IL-5, IL-6, IL-10 and IL-13) has been seen. Aim: To assess the baseline immunological parameters in drug naïve patients of schizophrenia, compare the levels of interleukins-2,6 and 8 in patients on clozapine and risperidone at baseline, 6 weeks and 12 weeks and study their correlation with clinical response. Material and methods: It was a prospective, randomized, and comparative study. Patients with ICD 11 diagnosis of Schizophrenia were randomized to receive either clozapine or risperidone after baseline assessment of socio- demographic and clinical parameters, baseline blood investigations, immunoglobulins and estimation of interleukin (IL-2, 6 and 8) levels. Levels of interleukins were reassessed at 6 weeks and 12 weeks along with application of PANSS and Glasgow antipsychotic side effect check list. Results: 54 of 65 patients completed the study; 30 patients in clozapine group and 24 in risperidone group. A significant rise was seen in IL-2 levels over 12 weeks. There was decrease in IL-6 levels which correlated with the decrease in positive symptoms at week 12. IL-8 had a negative correlation with the general psychopathology score at week 6 which continued till week 12. Risperidone did not have a significant alteration in the interleukin levels over the 12 weeks. Conclusion: It can be concluded that the elevated cytokine levels (IL-6) at baseline in both clozapine and risperidone groups validate the inflammatory basis of schizophrenia and may be used as the state marker for schizophrenia.