Key result
Elevated admission CRP links to increased aggressive behavior and restraint use in schizophrenia inpatients.
Why the study?
An association between inflammation and aggression in schizophrenia inpatients was of growing interest but not well characterized.
Is elevated C-reactive protein associated with aggressive behavior in adult schizophrenia inpatients?
Observational (n=213)
Is elevated C-reactive protein associated with aggressive behavior in adult schizophrenia inpatients?
p-value: p=0.012
Elevated CRP levels at admission are associated with increased aggressive behavior, such as higher rates of restraint and PANSS-EC scores, in schizophrenia inpatients.
May support CRP as an aggression risk marker in schizophrenia inpatients; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: An association between inflammation and behavioral domains of mental disorders is of growing interest. Recent studies reported an association between aggression and inflammation. In this study, we investigated the association between aggressive behavior and inflammatory markers in schizophrenia inpatients. METHODS: Adult schizophrenia inpatients without affective symptoms (n=213) were retrospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP>1 mg/dL; n=57) or normal (CRP<1 mg/dL; n=156). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints and suicidal behavior during hospitalization. Univariate comparisons between elevated and normal CRP levels were performed and multivariate analysis was conducted to control for relevant covariates. RESULTS: CRP levels significantly correlated with other laboratory markers indicating increased inflammation including leukocyte count and neutrophil to lymphocyte ratio (r=0.387, P<0.0001 and r=0.356, P<0.0001) respectively. Inpatients with elevated C-reactive protein displayed increased aggressive behavior compared to patients with normal CRP levels (<1 mg/dL). This was manifested by higher rates of restraint during hospitalization (χ(2)=5.22, P=0.031) and increased PANSS-EC score (U=5410.5, P=0.012). Elevated CRP levels were not associated with suicidal behavior. Multivariate analysis revealed that higher PANSS-EC score was associated with elevated CRP after controlling for the covariates age, sex, BMI and smoking. CONCLUSION: This study identified a potential biological correlate (inflammation) of a specific behavioral endophenotype (aggression) in schizophrenia inpatients.
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Barzilay et al. (2015) conducted an observational in Schizophrenia (n=213). Elevated C-reactive protein (CRP >1 mg/dL) vs. Normal C-reactive protein (CRP <1 mg/dL) was evaluated on Aggressive behavior (PANSS excitement component, restraints and suicidal behavior during hospitalization) (p=0.012). Elevated C-reactive protein (>1 mg/dL) at admission in schizophrenia inpatients was associated with increased aggressive behavior, including higher rates of restraint (P=0.031) and PANSS-EC (P=0.012).
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