The Role of Total White Blood Cell Count in Antipsychotic Treatment for Patients with Schizophrenia.

Dai Zhang, Shiwan Tao, Hao Yan, Xin Ma, Qi Chen, Tao Li, Qiang Wang, Wei Wei, Hongyan Zhang, Wei Deng, Lifang Wang, Luxian Lv, Weihua Yue, Fuquan Zhang, Yamin Zhang, Tianlan Lu, Keqing Li, Lingjiang Li, Xiaohong Ma, Wanjun Guo, Jeremy Coid, Liansheng Zhao, Fude Yang, Qingrong Tan, Jianli Yang, Guigang Yang, Chuanyue Wang, Liwen Tan

Journal: Current neuropharmacology 2023;22(1):159-167

PMID: 36600620

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Abstract

BACKGROUND

Total white blood cell count (TWBCc), an index of chronic and low-grade inflammation, is associated with clinical symptoms and metabolic alterations in patients with schizophrenia. The effect of antipsychotics on TWBCc, predictive values of TWBCc for drug response, and role of metabolic alterations require further study.

METHODS

Patients with schizophrenia were randomized to monotherapy with risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, perphenazine or haloperidol in a 6-week pharmacological trial. We repeatedly measured clinical symptoms, TWBCc, and metabolic measures (body mass index, blood pressure, waist circumference, fasting blood lipids and glucose). We used mixed-effect linear regression models to test whether TWBCc can predict drug response. Mediation analysis to investigate metabolic alteration effects on drug response.

RESULTS

At baseline, TWBCc was higher among patients previously medicated. After treatment with risperidone, olanzapine, quetiapine, perphenazine, and haloperidol, TWBCc decreased significantly ( < 0.05). Lower baseline TWBCc predicted greater reductions in Positive and Negative Syndrome Scale (PANSS) total and negative scores over time ( < 0.05). We found significant mediation of TWBCc for effects of waist circumference, fasting low-density lipoprotein cholesterol, and glucose on reductions in PANSS total scores and PANSS negative subscale scores ( < 0.05).

CONCLUSION

TWBCc is affected by certain antipsychotics among patients with schizophrenia, with decreases observed following short-term, but increases following long-term treatment. TWBCc is predictive of drug response, with lower TWBCc predicting better responses to antipsychotics. It also mediates the effects of certain metabolic measures on improvement of negative symptoms. This indicates that the metabolic state may affect clinical manifestations through inflammation.

Address: Department of Neurobiology and Affiliated Mental Health Center, Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.; Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, Zhejiang, China.; NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, China.; Mental Health Center and Psychiatric Laboratory, West China Hospital of Sichuan University, Chengdu, Sichuan, China.; Peking University Sixth Hospital (Institute of Mental Health), Beijing, China.; National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.; Second Xiangya Hospital, Central South University, Changsha, Hunan, China.; Beijing Anding Hospital, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.; Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China.; Wuxi Mental Health Center, Nanjing Medical University, Wuxi, Jiangshu, China.; Institute of Mental Health, Tianjin Anding Hospital, Tianjin, China.; Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China.; Hebei Mental Health Center, Baoding, Hebei, China.; Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China.; Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China.

DOI: 10.2174/1570159X21666230104090046

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MeSH Terms: Humans, Antipsychotic Agents, Schizophrenia, Olanzapine, Risperidone, Quetiapine Fumarate, Haloperidol, Perphenazine, Benzodiazepines, Glucose, Inflammation