Hemogram parameters in childhood anxiety disorders: Could anxiety disorders be related with inflammation?

Exploring the relationship between serum LOX-1, Ox-LDL, and generalized anxiety disorder

OBJECTIVE

This study aimed to explore the serum concentrations of lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and oxidized low-density lipoprotein (Ox-LDL), alongside their associations with haematological parameters in individuals diagnosed with generalized anxiety disorder (GAD).

METHODS

The study included 40 drug naive patients diagnosed with GAD and 40 healthy controls similar in gender, age, and Body Mass Index (BMI). Laboratory values and Ox-LDL and LOX-1 levels were measured. The severity of GAD was evaluated using the Hamilton Anxiety Rating Scale (HARS).

RESULTS

Serum Ox-LDL levels were significantly elevated in the GAD group compared to the control group (p = 0.005). However, no significant difference was observed in LOX-1 levels between the groups (p = 0.104). The neutrophil/lymphocyte ratio (NLR) differed significantly (p = 0.027). A robust positive correlation emerged between Ox-LDL levels and HARS scores (r = 0.467, p = 0.002), and between Ox-LDL and LOX-1 (r = 0.345, p = 0.029).

CONCLUSION

This study suggests that serum Ox-LDL and NLR may have a potential role in the relationship between oxidative stress and inflammation in the pathophysiology of GAD. This is the first study investigating the interaction between Ox-LDL, LOX-1, haematological parameters and GAD and underlines the need for further research in this field.

Markers of inflammation in patients with generalized anxiety disorder

Purpose: The aim of this study was to analyze the systemic immune response index, systemic immune inflammation index, neutrophil/HDL, lymphocyte/HDL, platelet/HDL, and monocyte/HDL ratio, used as inflammatory markers in patients with generalized anxiety disorder (GAD). Materials and Methods: A total of 864 participants, including 432 healthy controls and 432 patients diagnosed with GAD, were included in this study. High-density lipoprotein (HDL-c) levels, neutrophil, monocyte, lymphocyte, and platelet counts; systemic inflammatory response index (SIRI), systemic immune-inflammatory index (SII), neutrophil/high-density lipoprotein ratio (NHR), lymphocyte/high-density lipoprotein ratio (LHR), monocyte/high-density lipoprotein ratio (MHR), and platelet/high-density lipoprotein ratio (PHR) were calculated. Results: The median age of the case group was 35.50 (interquartile range: 28.00-44.00), while the median age of the control group was 35.00 (interquartile range: 28.00-44.00). In the GAD group, neutrophils, monocytes, SII, SIRI, NHR, LHR, MHR, and PHR were significantly higher, while platelets and HDL were significantly lower. Conclusions: This study highlights that elevated systemic inflammation markers, such as SII and SIRI, along with altered HDL ratios, may be associated with GAD. The findings support the hypothesis that inflammation plays a role in the etiopathogenesis of GAD, potentially contributing to both diagnosis and management.

Neuroinflammation and mental health outcomes in adolescents living with HIV

PURPOSE OF REVIEW

Adolescents living with HIV show chronic inflammation, which in turn has been linked to mental health outcomes in the general population. The increased risk for mental health issues in adolescents with HIV may thus be driven by HIV-related inflammation. In this review, we discuss the associations between peripheral and central nervous system inflammation and mental health outcomes in adolescents with HIV.

RECENT FINDINGS

Preclinical models indicate that expression of HIV viral proteins early in life may lead to neuroinflammation and behavioural deficits in adolescence. Clinical evidence is available primarily in the general population and in adults with HIV, and suggests that inflammatory biomarkers such as IL-6 and TNF-α may be associated with depressive symptoms. Only one study has explored these relationships in adolescents with HIV, and did not find that inflammatory biomarkers in the blood or brain were linked to depressive symptoms. Current research in this field focuses overwhelmingly on peripheral inflammatory biomarkers (compared to neuroimaging biomarkers) and on depression (compared to other mental health conditions).

SUMMARY

There is strong evidence to suggest that neuroinflammation and peripheral inflammation may play a role in the development of mental health issues in adolescents, but research in adolescents with HIV is sparse. Characterizing the relationship between inflammation and mental health in adolescents with HIV may help improve the prediction, prevention, early intervention, and treatment of mental health issues in this population.

The association of hematological inflammatory markers and psychological function in COVID-19 patients: A cross-sectional study

Mental health disorders are linked to systemic inflammation. Due to high inflammation and mental health disorders in COVID-19 patients, we aimed to investigate the relationship between blood inflammatory markers such as red cell distribution width to platelet ratio (RPR), platelet-lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), white blood cell (WBC), and psychological function in COVID-19 patients. In the current cross-sectional study, neuro-psychological function, and a complete blood count (CBC) were measured on 120 COVID-19 patients aged >30 years from the Imam Reza Hospital in Mashhad, Iran. Our results showed that anxiety related to MCHC (mean ± SD: 32.71 ± 1.68, p < 0.05), WBC (mean ± SD: 12.23 ± 5.43, p < 0.05), and PLR (median (IQR): 28.72 (15.88-41.31), p < 0.05) significantly. In the stress subgroup, only RPR was associated with stress (p < 0.05). Linear regression between hematological parameters and psychological score indicated that RDW and PLR had a significantly positive association with depression (β = 0.086; p = 0.045 and β = 1.326; p = 0.016, respectively) and anxiety scores (β = 0.100; p = 0.038 and β = 1.356; p = 0.010, respectively). Moreover, a positive correlation was found between PLR and stress (β = 1.102; p = 0.012). This study showed a positive association between depression/anxiety/stress symptoms and levels of hematological inflammatory markers including PLR and RDW. The findings of this study provide novel insights into mental health and physiological markers, underscoring the potential influence of inflammation on mood disorders. Our findings offer exciting prospects for future research and may lead to innovative approaches in the management and treatment of depression, anxiety, and stress.

Platelet and white blood-cell-based ratios: Differential inflammatory markers of severe mental disorders?

INTRODUCTION

Neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), and platelet/lymphocyte (PLR) ratios, and systemic inflammatory index (SII) represent peripheral markers of inflammation associated with different severe mental disorders.

MATERIAL AND METHODS

In this study, these parameters were analyzed in a sample of 622 participants [197 patients with major depressive disorder (MDD), 154 with bipolar disorder (BD), 176 with schizophrenia (SCH), and 95 healthy controls (HC)]. Sociodemographic and clinical data of patients were recorded.

RESULTS

Differences in age and sex were detected among groups (p<0.001), with SCH patients being younger and MDD patients being older. After stratifying by sex, these ratios were compared using the nonparametric ANCOVA (Quade's test) using age as a covariate. In males, no significant statistical differences were found between groups. However, differences were observed in MLR in the subgroup of females [MDD: 0.23 (SD=0.09); BD: 0.23 (SD=0.11); SCH: 0.24 (SD=0.11); HC: 0.29 (SD=0.13); F=5.376, p=0.001]. Post hoc testing revealed that there are MLR differences between HC versus MDD and between HC versus BD, with higher values in HC versus the other two groups. On the other hand, no differences were found in either males or females for any of the studied ratios, among the three diagnostic groups.

CONCLUSIONS

MLR is reduced in MDD and BD patients versus HC, but exclusively in the female group. However, based on the analyzed indices, it is not possible to differentiate among the three diagnostic groups of patients. As a limitation of this study, note that the effects of psychopharmacological treatments and smoking have not been controlled for.

Neutrophil-lymphocyte ratios as inflammatory biomarkers in psychiatric patients

PURPOSE

There is a growing amount of evidence to suggest that inflammation may have a role in the onset and prognosis of psychiatric disorders. We reviewed the literature of studies investigating neutrophil-lymphocyte ratios (NLR), a biomarker of inflammation, in both adult and youth psychiatric populations. The limitations of NLR, in addition to the potential mechanisms underlying its relationship with psychiatric disorders, are also discussed.

RECENT FINDINGS

Unlike in the general population, NLR is elevated in a proportion of adult patients with schizophrenia, major depressive disorder and bipolar disorder, though associations with symptom severity and other clinical parameters are less clear. When compared to baseline, reductions in NLR are sometimes reported after treatment and remission. Results in youth populations largely resemble findings obtained from adult samples, even though youth studies are far fewer in number.

SUMMARY

The consistent findings of elevated NLR across the reviewed psychiatric disorders suggest that abnormal NLR is not specific to any one disorder but may reflect a pathological brain process that leads to brain dysfunction. These findings support hypotheses of neuroinflammation being important to the etiology of psychiatric disorders. More research is needed to further elucidate the relationship between specific diagnostic and behavioural constructs and NLR. Future work is also needed to determine the specific neuroinflammatory mechanisms that give rise to specific disorders.

Elevated levels of monocyte-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with non-suicidal self-injury

BACKGROUND

Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) are blood indicators of systemic inflammation. This study aims to compare the levels of inflammatory indicators derived from blood routine tests between adolescents with non-suicidal self-injury (NSSI) and those with non-NSSI.

METHODS

A total of 201 adolescents with mood or emotional disorders were enrolled in this study, among which 106 had engaged in NSSI and 95 had never engaged in NSSI. NLR, MLR, and PLR were calculated based on the complete blood cell count.

RESULTS

There was no significant difference in demographic data between the two groups. The NSSI group exhibited significantly higher MLR (P = 0.001) and PLR (P = 0.007) than the non-NSSI group. Multivariate logistic regression analysis revealed that MLR (OR 1.545, 95%CI [1.087-2.281], P = 0.021) and PLR (OR 1.327, 95%CI [1.215-1.450], P < 0.001) were independently associated with NSSI. Receiver operating characteristic (ROC) curve analyses demonstrated that for differentiating NSSI from non-NSSI, the optimal cut-off value of MLR was 0.135 and the area under curve was 0.638 ([0.561- 0.715], P < 0.001), with a sensitivity of 90.60% and a specificity of 33.70%; the optimal cut-off value of PLR was 127.505 and the area under curve was of 0.611 ([0.533-0.689], P < 0.001), with a sensitivity of 39.60% and a specificity of 81.10%.

CONCLUSIONS

Systemic inflammation, as indicated by elevated MLR and PLR, was found to be strongly associated with NSSI among adolescents.

Origin of Sex-Biased Mental Disorders: Do Males and Females Experience Different Selective Regimes?

The origins of sex-biased differences in disease and health are of growing interest to both medical researchers and health professionals. Several major factors have been identified that affect sex differences in incidence of diseases and mental disorders. These are: sex chromosomes, sex hormones and female immunity, sexual selection and antagonistic evolution, and differential susceptibility of sexes to environmental factors. These factors work on different time scales and are not exclusive of each other. Recently, a combined Sexual Selection-Sex Hormones (SS-SH) Theory was presented as an evolutionary mechanism to explain sex-biased differences in diseases and mental disorders (Singh in J Mol Evol 89:195-213, 2021). In that paper disease prevalence trends were investigated, and non-sex-specific diseases were hypothesized to be more common in males than in females in general. They showed signs of exceptions to this trend with inflammatory diseases and stress-related mental disorders that were more common in females. We believe that the SS-SH theory requires the consideration of psycho-social stress (PSS) to explain the predominance of female-biased mental disorders and some other exceptions in their findings. Here we present a theory of sex-differential experience of PSS and provide quantitative support for the combined SS-SH-PSS Theory using age-standardized incidence rates (ASIRs) recording the levels of male- and female-bias in data obtained from different countries. The grand theory provides an evolutionary framework for explaining patterns of sex-biased trends in the prevalence of disease and health. Further exploration of women's vulnerability to social factors may help to facilitate new treatments for female-biased diseases.

The endocannabinoid system in social anxiety disorder: from pathophysiology to novel therapeutics

Social anxiety disorder (SAD) is a highly prevalent psychiatric disorder that presents with an early age of onset, chronic disease course, and increased risk of psychiatric comorbidity. Current treatment options for SAD are associated with low response rates, suboptimal efficacy, and possible risk of adverse effects. Investigation of new neurobiological mechanisms may aid in the identification of more specific therapeutic targets for the treatment of this disorder. Emerging evidence suggests that the endogenous cannabinoid system, also referred to as the endocannabinoid system (ECS), could play a potential role in the pathophysiology of SAD. This review discusses the known pathophysiological mechanisms of SAD, the potential role of the ECS in this disorder, current drugs targeting the ECS, and the potential of these novel compounds to enhance the therapeutic armamentarium for SAD. Further investigational efforts, specifically in human populations, are warranted to improve our knowledge of the ECS in SAD.