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Clinically relevant and simple immune system measure is related to symptom burden in bipolar disorder

Published online by Cambridge University Press:  07 December 2017

Ole Köhler-Forsberg Open the ORCID record for Ole Köhler-Forsberg [Opens in a new window] ,
Louisa Sylvia ,
Thilo Deckersbach ,
Michael Joshua Ostacher ,
Melvin McInnis ,
Dan Iosifescu ,
Charles Bowden ,
Susan McElroy ,
Joseph Calabrese  and
Michael Thase
...Show all authors
Ole Köhler-Forsberg*
Affiliation:
Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark
Louisa Sylvia
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Thilo Deckersbach
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Michael Joshua Ostacher
Affiliation:
VA Palo Alto Health Care System, Palo Alto, CA, USA Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
Melvin McInnis
Affiliation:
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
Dan Iosifescu
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Charles Bowden
Affiliation:
Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
Susan McElroy
Affiliation:
Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA Lindner Center of HOPE, Mason, OH, USA
Joseph Calabrese
Affiliation:
Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
Michael Thase
Affiliation:
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
Richard Charles Shelton
Affiliation:
Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
Mauricio Tohen
Affiliation:
Department of Psychiatry, University of New Mexico Health Science Center, Albuquerque, NM, USA
James Kocsis
Affiliation:
Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
Edward Friedman
Affiliation:
Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Terence Ketter
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
Andrew Alan Nierenberg
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
*
Ole Köhler-Forsberg, Psychosis Research Unit, Aarhus University Hospital, Risskov, Skovagervej 2, DK-8240 Risskov, Denmark. Tel: +45 2342 0661 Fax: +45 7847 1609 E-mail: karkoe@rm.dk
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Abstract

Objective

Immunological theories, particularly the sickness syndrome theory, may explain psychopathology in mood disorders. However, no clinical trials have investigated the association between overall immune system markers with a wide range of specific symptoms including potential gender differences.

Methods

We included two similar clinical trials, the lithium treatment moderate-dose use study and clinical and health outcomes initiatives in comparative effectiveness for bipolar disorder study, enrolling 765 participants with bipolar disorder. At study entry, white blood cell (WBC) count was measured and psychopathology assessed with the Montgomery and Aasberg depression rating scale (MADRS). We performed analysis of variance and linear regression analyses to investigate the relationship between the deviation from the median WBC, and multinomial regression analysis between different WBC levels. All analyses were performed gender-specific and adjusted for age, body mass index, smoking, race, and somatic diseases.

Results

The overall MADRS score increased significantly for each 1.0×109/l deviation from the median WBC among 322 men (coefficient=1.10; 95% CI=0.32–1.89; p=0.006), but not among 443 women (coefficient=0.56; 95% CI=−0.19–1.31; p=0.14). Among men, WBC deviations were associated with increased severity of sadness, inner tension, reduced sleep, reduced appetite, concentration difficulties, inability to feel, and suicidal thoughts. Among women, WBC deviations were associated with increased severity of reduced appetite, concentration difficulties, lassitude, inability to feel, and pessimistic thoughts. Both higher and lower WBC levels were associated with increased severity of several specific symptoms.

Conclusion

Immune system alterations were associated with increased severity of specific mood symptoms, particularly among men. Our results support the sickness syndrome theory, but furthermore emphasise the relevance to study immune suppression in bipolar disorder. Due to the explorative nature and cross-sectional design, future studies need to confirm these findings.

Keywords

affective disorderbipolar disorderclinical trialslithiummood stabiliserspsychoneuroimmunology
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 30 , Issue 5 , October 2018 , pp. 297 - 305
Copyright
© Scandinavian College of Neuropsychopharmacology 2017 

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