Polyunsaturated fatty acids, prostaglandins, and schizophrenia

Investigating the Impacts of Diet, Supplementation, Microbiota, Gut-Brain Axis on Schizophrenia: A Narrative Review

Schizophrenia is a disease with a complex etiology that significantly impairs the functioning of patients. In recent years, there has been increasing focus on the importance of the gut microbiota in the context of the gut-brain axis. In our study, we analyzed data on the gut-brain axis in relation to schizophrenia, as well as the impacts of eating habits, the use of various supplements, and diets on schizophrenia. Additionally, the study investigated the impact of antipsychotics on the development of metabolic disorders, such as diabetes, dyslipidemia, and obesity. There may be significant clinical benefits to be gained from therapies supported by supplements such as omega-3 fatty acids, B vitamins, and probiotics. The results suggest the need for a holistic approach to the treatment of schizophrenia, incorporating both drug therapy and dietary interventions.

Polyphenols from Berries of Aronia melanocarpa Reduce the Plasma Lipid Peroxidation Induced by Ziprasidone

Background. Oxidative stress in schizophrenia may be caused partially by the treatment of patients with antipsychotics. The aim of the study was to establish the effects of polyphenol compounds derived from berries of Aronia melanocarpa (Aronox) on the plasma lipid peroxidation induced by ziprasidone in vitro. Methods. Lipid peroxidation was measured by the level of thiobarbituric acid reactive species (TBARS). The samples of plasma from healthy subjects were incubated with ziprasidone (40 ng/ml; 139 ng/ml; and 250 ng/ml) alone and with Aronox (5 ug/ml; 50 ug/ml). Results. We observed a statistically significant increase of TBARS level after incubation of plasma with ziprasidone (40 ng/ml; 139 ng/ml; and 250 ng/ml) (after 24 h incubation: P = 7.0 × 10(-4), P = 1.6 × 10(-3), and P = 2.7 × 10(-3), resp.) and Aronox lipid peroxidation caused by ziprasidone was significantly reduced. After 24-hour incubation of plasma with ziprasidone (40 ng/ml; 139 ng/ml; and 250 ng/ml) in the presence of 50 ug/ml Aronox, the level of TBARS was significantly decreased: P = 6.5 × 10(-8), P = 7.0 × 10(-6), and P = 3.0 × 10(-5), respectively. Conclusion. Aronox causes a distinct reduction of lipid peroxidation induced by ziprasidone.

Sleep Disruption and Proprioceptive Delirium due to Acetaminophen in a Pediatric Patient

We present the case of a 7-year-old boy, who received acetaminophen for the treatment of hyperpyrexia, due to an infection of the superior airways. 13 mg/kg (260 mg) of acetaminophen was administered orally before bedtime, and together with the expected antipyretic effect, the boy experienced sleep disruption and proprioceptive delirium. The symptoms disappeared within one hour. In the following six months, acetaminophen was administered again twice, and the reaction reappeared with similar features. Potential alternative explanations were excluded, and analysis with the Naranjo algorithm indicated a “probable” relationship between acetaminophen and this adverse reaction. We discuss the potential mechanisms involved, comprising imbalances in prostaglandin levels, alterations of dopamine, and cannabinoid and serotonin signalings.

Lipid peroxidation in patients with schizophrenia

AIMS

There is evidence that dysregulation of free radicals metabolism associated with abnormal activities of antioxidative enzymes in schizophrenia can lead to lipid peroxidation in plasma, erythrocytes, blood platelets and cerebrospinal fluid. Injury to neurons in schizophrenia may affect their function, i.e. membrane transport, impairment of energy production in mitochondria, changes in membrane phospholipid composition, alteration of receptors and transporters as well as neurotransmission. The purpose of the present study was to assess the total antioxidant capacity (TAC) and lipid peroxidation (expressed as the level of thiobarbituric acid reactive substances [TBARS]) in plasma from schizophrenic patients taking olanzapine or risperidone. The level of TBARS estimated according to the Rice-Evans method and TAC ([ABTS; 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) radical cation decolorization assay]) in plasma from schizophrenic patients (DSM-IV criteria for schizophrenia, n = 30, age 18-36) taking olanzapine or risperidone and from healthy volunteers (n = 30) were measured.

METHODS

The level of TBARS in plasma from healthy volunteers after incubation with olanzapine or risperidone was also estimated.

RESULTS

Significantly lower plasma TAC (P < 0.05) and significantly increased level of TBARS (P < 0.001) in schizophrenic patients were observed. The in vitro study showed that after olanzapine or risperidone (at final concentrations corresponding to doses used in acute episodes of schizophrenia treatment) no changes of plasma lipid peroxidation were found (P > 0.05). The obtained results indicate that the pro-oxidant disturbances occur in schizophrenic patients (acute episode) taking stable doses of olanzapine or risperidone.

CONCLUSION

It seems that second-generation antipsychotics (olanzapine and risperidone) are not responsible for increase of plasma lipid peroxidation.

Depressive psychosis associated with a cyclo oxygenase 2 inhibitor (meloxicam)

We describe a 60 year old man who developed a fluctuating depressive psychosis associated with meloxicam, a non-steroidal anti-inflammatory drug (NSAID). The psychological symptoms observed were temporally related to the administration of meloxicam and occurred in the presence of signs of meloxicam intolerance, such as skin rash and raised blood pressure. The depressive reaction resolved quickly following cessation of meloxicam, recurring on re-exposure. The psychiatric manifestations of NSAID intolerance are rare, however 40% of cases have a history of mental illness. Data from adverse event reporting systems suggest that the newer NSAIDs (COX-2 inhibitors) may have a higher propensity to cause psychiatric adverse effects and should be used with caution in individuals with a history of mental illness. This data may be provocative given current research in to the use of COX-2 inhibitors in augmenting neuroleptic treatment in schizophrenia.

Isoprostenes as indicators of oxidative stress in schizophrenia

OBJECTIVE

Free radicals induce oxidative stress and damage to all types of biological molecules and may be involved in pathology of schizophrenia. A cell membrane dysfunction caused by lipid peroxidation can be secondary to a free radical-mediated pathology and may contribute to specific aspects of schizophrenic symptomatology and complications of its treatment.

METHOD

The aim of our study was to estimate oxidative stress in a group of schizophrenic patients by using different biomarkers of free radicals-induced lipid peroxidation (isoprostanes, thiobarbituric acid reactive substances (TBARS)). We also determined the products of enzymatic peroxidation of arachidonic acid, such as thromboxane B2 (TXB2) and its metabolite 11-dehydrothromboxane B2. Isoprostanes (IPs) are a family of novel prostaglandin isomers and are produced in free radical-catalysed reactions from arachidonic acid. They are useful as a specific, sensitive, chemically stable, noninvasive index of free radical generation in vivo. We therefore assessed in schizophrenic patients and control subjects the level of urinary excretion of isoprostane--8-epi-prostaglandin F2 alpha, (8-isoPGF2 alpha)--a marker of lipid peroxidation induced by free radicals using an immunoassay kit. We also studied the level of the other marker of enzymatic arachidonic acid peroxidation--11-dehydrothromboxane B2--in urine from schizophrenic patients and healthy volunteers. Moreover, we estimated the production of TBARS and TXB2 in plasma from schizophrenic patients and the control group. Patients hospitalised in the II Psychiatric Department of Medical University in Lodz, Poland, were interviewed with a special questionnaire (treatment, course of diseases, dyskinesis and other EPS). According to DSM-IV criteria, all patients had diagnosis of paranoid type. All patients were treated with second-generation antipsychotic drugs (risperidone, clozapine, and olanzapine). Mean time of schizophrenia duration was about 2 years.

RESULTS

We observed a statistically increased level of TBARS in plasma (P=0.000162) and isoprostanes (P=3.5 x 10(-12)) in urine of schizophrenic patients in comparison with the control group. The level of markers of enzymatic oxidation of arachidonic acid (TXB2 and its metabolite, 11-dehydrothromboxane B2) did not change. This indicates that free radicals induce peroxidation of unsaturated fatty acid in schizophrenic patients.

CONCLUSION

Considering the data presented in this study, we suggest that non-invasive measurement of 8-isoPGF2 alpha, is a valuable and sensitive (contrary to TBARS) indicator of oxidative stress status in vivo in schizophrenia.

Oxidative stress in blood platelets from schizophrenic patients

Oxidative stress in blood platelets is observed in various diseases, including neuropsychiatric disorders. The aim of our study was to evaluate oxidative stress in blood platelets from patients with schizophrenic disorders by measuring the activity of the platelet antioxidative enzyme, superoxide dismutase (SOD), concomitant with the level of thiobarbituric acid reactive species (TBARS). In blood platelets obtained from schizophrenic patients (with paranoid schizophrenia according to DSM-IV criteria) and from healthy volunteers the level of reactive oxygen species was also measured via chemiluminescence. In resting blood platelets from schizophrenic patients the chemiluminescence was higher than in platelets from control subjects (P < 0.05), but in thrombin-activated platelets an increase (about 53%) of chemiluminescence was observed, however this increase was lower than in thrombin-stimulated platelets from healthy subjects (101.5%). The results indicate that in platelets from schizophrenic patients generation of reactive oxygen species is enhanced. Moreover, we observed that SOD activity in blood platelets from schizophrenic patients was significantly lower than in control platelets and that a correlation exists between increased lipid peroxidation and inhibition of the activity of this antioxidative enzyme in schizophrenic platelets.

NSAID-related psychiatric adverse events: who is at risk?

NSAIDs are frequently used in clinical practice and they account for approximately 5-10% of all drug prescriptions. NSAID use has been associated with a risk of adverse events, which have a relevant impact on morbidity and mortality and account for a substantial increment of healthcare costs. Less common, but clinically relevant, adverse events associated with NSAID use are the impairment of the CNS and, particularly, the appearance of psychiatric symptoms. These symptoms include changes in cognition, mood state and even precipitation or exacerbation of pre-existing psychiatric disorders. This article aims to review the medical literature on published reports of NSAID-related psychiatric adverse events, identify risk factors for these events and describe mechanisms potentially involved in their onset. We identified 27 reports with data on 453 cases of NSAID-related psychiatric adverse events. Data suggest that individuals who may be particularly susceptible to such events include patients with a history of psychiatric illness and possibly parturients. Indometacin and selective cyclo-oxygenase (COX)-2 inhibitors were the most frequently reported culprit drugs; however, whether this reflects an increased incidence with these drugs compared with other NSAIDs or factors such as usage or reporting patterns is unknown.A possible explanation for the psychiatric effect of NSAIDs resides in the modulation of central neurotransmission by prostaglandins, the synthesis of which is inhibited by NSAIDs. COX-2 is a key enzyme in this process since its activity is localised in distal dendrites and dendritic spines, which are cellular specialisations involved in synaptic signalling. Dopamine is considered the most relevant neurotransmitter involved in this phenomenon. Psychiatric symptoms are a rare but relevant complication of NSAID use. This effect is probably a consequence of impairment in neurotransmission modulated by prostaglandins when NSAIDs are used by susceptible individuals. These drugs should be used with caution in high-risk individuals with pre-existing psychiatric illness, and caution may also be advisable in the postpartum period. To date, reports of NSAID-related psychiatric adverse events have most commonly involved indometacin and selective COX-2 inhibitors. Prescribers should consider warning patients of the possibility of an acute neuropsychiatric event when traditional NSAIDs or selective COX-2 inhibitors are prescribed.

Oxidative damage and schizophrenia: an overview of the evidence and its therapeutic implications

Free radicals are highly reactive chemical species generated during normal metabolic processes. which in excess can lead to membrane damage. Elaborate antioxidant defence systems exist to protect against oxidative stress. There is accumulating evidence of altered antioxidant capacity in schizophrenia. Membrane dysfunction can be secondary to free radical-mediated pathology, and may contribute to specific aspects of schizophrenic symptomatology and complications of its treatment. Specifically, free radical-mediated abnormalities may contribute to the development of a number of clinically significant consequences, including prominent negative symptoms, tardive dyskinesia, neurological 'soft' signs and parkinsonian symptoms. Our previous results showing altered membrane dynamics and antioxidant enzyme activities in schizophrenia, and findings from other investigators, are consistent with the notion of free radical-mediated neurotoxicity in schizophrenia. These findings provide a theoretical basis from which the development of novel therapeutic strategies such as fatty acid and antioxidant supplementation can occur in the future.

Oxidative stress and role of antioxidant and omega-3 essential fatty acid supplementation in schizophrenia

1. Schizophrenia is a major mental disorder that has a lifetime risk of 1% and affects at young age (average age at the onset 24 +/- 4.6 years) in many cultures around the world. The etiology is unknown, the pathophysiology is complex, and most of the patients need treatment and care for the rest of their lives. 2. Cellular oxidative stress is inferred from higher tissue levels of reactive oxygen species (ROS, e.g., O2*-, OH*, OH-, NO* and ONOO--) than its antioxidant defense that cause peroxidative cell injury, i.e., peroxidation of membrane phospholipids, particularly esterified essential polyunsaturated fatty acids (EPUFAS), proteins and DNA. 3. Oxidative stress can lead to global cellular with predominantly neuronal peroxidation, since neurons are enriched in highly susceptible EPUFAs and proteins, and damages DNA is not repaired effectively. 4. Such neuronal peroxidation may affect its function (i.e., membrane transport, loss of mitochondrial energy production, gene expression and therefore receptor-mediated phospholipid-dependent signal transduction) that may explain the altered information processing in schizophrenia. 5. It is possible that the oxidative neuronal injury can be prevented by dietary supplementation of antioxidants (e.g., vitamins E, C and A; beta-carotene, Q-enzyme, flavons, etc.) and that membrane phospholipids can be corrected by dietary supplementation of EPUFAs. 6. It may be that the oxidative stress is lower in populations consuming a low caloric diet rich in antioxidants and EPUFAs, and minimizing smoking and drinking. 7. Oxidative stress exists in schizophrenia based on altered antioxidant enzyme defense, increased lipid peroxidation and reduced levels of EPUFAs. The life style of schizophrenic patients is also prooxidative stress, i.e., heavy smoking, drinking, high caloric intake with no physical activity and treatment with pro-oxidant drugs. 8. The patients in developed countries show higher levels of lipid peroxidation and lower levels of membrane phospholipids as compared to patients in the developing countries. 9. Initial observations on the improved outcome of schizophrenia in patients supplemented with EPUFAs and antioxidants suggest the possible beneficial effects of dietary supplementation. 10. Since the oxidative stress exists at or before the onset of psychosis the use of antioxidants from the very onset of psychosis may reduce the oxidative injury and dramatically improve the outcome of illness.

Co-distribution of sensory gating and impaired niacin flush response in the parents of schizophrenics

Complex illnesses may result from the interaction or addition of multiple factors. We examined the familial co-distribution of two abnormalities common in schizophrenia: impaired auditory sensory gating and impaired flush response to niacin. In ten families, the obligate carrier parent had sensory-gating deficits, while eight of the ten parents without a family history of schizophrenia had impaired flush response. No parents had both deficits. The data are consistent with a theory suggesting the interaction of these two factors in some cases of schizophrenia.

Genetic variant near cytosolic phospholipase A2 associated with schizophrenia

Two studies were undertaken to determine a possible genetic basis for alterations in phospholipid metabolism in schizophrenia. Initial results demonstrated an association in 65 schizophrenics compared with a matched normal control population. A follow-up haplotype relative risk study of 44 triads (mother, father, affected offspring), confirmed the results seen in the association study. Results suggest that a genetic variant near the promotor region of the gene for cytosolic phospholipase A2, the rate-limiting enzyme in the synthesis of prostaglandins from arachindonic acid, is associated with schizophrenia.

The niacin challenge test in schizophrenia: past, present and future

Schizophrenia, a complex, heterogeneous illness, represents a diagnostic challenge in that defining the clinical subtypes of this illness remains equivocal. Moreover, a scarcity of research has focused on the integration of the biochemical and clinical aspects of schizophrenia. Therefore, there is a need to approach the subtyping of schizophrenia with attention to potential clinical manifestations of underlying biochemical disturbances. In an attempt to subtype schizophrenia, we review some of the clinical and biochemical evidence for alterations in phospholipid function in schizophrenia.

Heat stress lipids and schizophrenia

The neurodevelopmental hypothesis of schizophrenia implicates abnormal or disrupted neural growth during embryogenesis. It is postulated here that stress-inducing agents acting upon a compromised cellular system resulting from abnormal plasma membrane lipids could effect the neuronal abnormalities observed in schizophrenia. The heat stress response is induced by exposure to hyperthermia as well as a variety of other agents. The response to these agents includes the cessation of most transcriptional and translational activities, accompanied by the induction of a highly specific set of proteins. A concomitant reduction in metabolic activity including cell cycle delays is also observed. Much of the enormous literature on the heat stress response concentrates on protein and DNA interactions, especially with regard to transcriptional control. However, a variety of lipids are intrinsically involved in the heat stress response. This paper will provide a brief introduction to the heat shock proteins and will explore the roles that lipids play in the heat shock response.

Phospholipases: in search of a genetic base of schizophrenia

Evidence from a variety of clinical and biochemical sources indicates alterations in phospholipid synthesis and activity in schizophrenia. We review a recent study which suggests that a genetic variant near the promotor region of the gene for cytosolic phospholipase A2, the rate-limiting enzyme in the synthesis of prostaglandins from arachidonic acid (AA), is associated with schizophrenia. These findings are consistent with a extensive body of literature which suggests alterations in membrane phospholipids in schizophrenia.

Utilization of precursor essential fatty acids in culture by skin fibroblasts from schizophrenic patients and normal controls

Based on the lower levels of long-chain polyunsaturated analogs of essential fatty acids (EPUFAs) in plasma membrane phospholipids of red blood cells, brain and cultured skin fibroblasts from schizophrenic patients, a defective utilization (uptake, conversion to EPUFAs and incorporation into membrane phospholipids) of precursor EFAs has been suggested. Utilization of radiolabeled linoleic (LA, 18:2(n-6)) and alpha-linolenic (ALA, 18:3(n-3)) acids was studied in cultured skin fibroblasts from patients with established schizophrenia and at the first episode of psychosis, and normal controls. Uptake and incorporation of both the EFAs were similar in fibroblasts from both groups of patients studied compared with normal controls. However, although the utilization of LA into arachidonic acid (AA, 20:4n-6) was similar in patients and controls, the utilization of eicosapentaenoic acid (EPA, 20:5(n-3)) into docosahexaenoic acid (DHA, 22:6(n-3)) was significantly lower in first-episode psychotic patients (patients, 96.33 +/- 27.16 versus normals, 161.66 +/- 26.33 nmoles per mg total protein; P = < 0.001). This data indicates that the level of delta 6- as well as delta 5-desaturase may be normal. However, the levels of delta 4-desaturase may be lower in fibroblasts from schizophrenic patients even at the first episode of psychosis.

Free radical pathology in schizophrenia: a review

There is evidence that free radicals are involved in membrane pathology, and may play a role in schizophrenia. Free radicals are reactive chemical species generated during normal metabolic processes, and, in excess, can damage lipids, proteins, and DNA. Regions of high oxygen consumption, lipid content, and transition metals are at particular risk. Hence, neuronal membranes are uniquely vulnerable to radical-mediated damage. Elaborate antioxidant defense systems exist to protect against oxidative stress. In schizophrenia there is evidence for dysregulation of free radical metabolism, as detected by abnormal activities of critical antioxidant enzymes and other indices of lipid peroxidation in plasma, red blood cells, and cerebrospinal fluid. Such abnormalities have been associated with tardive dyskinesia, negative symptoms, neurological signs, poor premorbid function, and CT scan abnormalities. Studies to date have generally been exploratory. Further elucidation of the role of free radicals and antioxidants in schizophrenia and its treatment will require systematic investigation.

Schizophrenia, tardive dyskinesia and essential fatty acids

Several reports have indicated that people suffering from schizophrenia show an associated abnormality in levels of certain essential fatty acids (EFAs) in blood cells. Similar abnormalities have also been noted in association with the presence of tardive dyskinesia (TD). In order to study this further, 72 patients with the diagnosis of schizophrenia or schizoaffective disorder were examined to assess the relationship between psychiatric status, movement disorder (TD) and relative levels of the n-3 and n-6 essential fatty acids in red blood cell membranes and plasma. Patients were followed up over the next 4.5 years to determine whether or not changes in clinical state showed any systematic relationship to changes in essential fatty acid levels. We hypothesised that patients with schizophrenia would show persistently lowered levels of n-6 and n-3 series essential fatty acids, compared with normal controls. We further hypothesised that this abnormality would be greater in the presence versus absence of TD and the dominance of negative rather than positive symptoms. The only consistent findings were that lower levels of linoleic acid and higher levels of dihomogamma-linolenic acid characterised the patient population compared with control subjects but there was considerable variability in patients' EFA profile.

[3H]dopamine uptake by platelet storage granules in schizophrenia

[3H]Dopamine (DA) uptake by platelet storage granules was determined in 26 schizophrenic male patients, paranoid type (14 acute stage; 12 in remission) and 20 age-matched, normal controls. Maximum velocity (Vmax) of DA uptake was significantly higher in acute patients, than patients in remission or controls (p less than 0.05). The apparent Michaelis constant (Km) of DA uptake in acute patients was also significantly different from chronic patients (p less than 0.05). Preincubation with reserpine (10(-4), 10(-5) M) produced a substantial diminution of DA uptake, while haloperidol (10(-4), 10(-5) M) did not affect the assay. Considering that a DA dysequilibrium in schizophrenia may be expressed not only in the brain, but also in the periphery and that an increased amount of DA accumulated in the vesicles, implies that an increased quantity of catecholamine is available for release, our findings suggest additional evidence for the role of DA overactivity in the pathophysiology of this disorder.

Fatty acids in plasma phospholipids and cholesterol esters from identical twins concordant and discordant for schizophrenia

The fatty acid compositions of plasma phospholipids and cholesterol esters were measured in 18 pairs of twins discordant for schizophrenia and 20 pairs concordant for schizophrenia. In the twins discordant for schizophrenia the only significant abnormalities were elevations of adrenic (22:4n-6) and docosapentaenoic (22:5n-6) acids in the schizophrenic twins. These fatty acids have also recently been reported to be elevated in brains from schizophrenics. The twins concordant for schizophrenia showed many differences from the normal discordant twins. 22:4n-6 and 22:5n-6 were even more abnormal than in the schizophrenic discordant twins. In addition, linoleic acid was significantly reduced, an abnormality which has been found consistently in other schizophrenic populations. These observations are consistent with the concept that unsaturated fat metabolism may be abnormal in schizophrenia.

Dopamine and norepinephrine activity in schizophrenia. An integrative perspective

The dopamine (DA) hypothesis of schizophrenia stated that increased DA activity is the primary cause of schizophrenia. Recently, even though increased DA activity is in fact involved in psychotic symptoms and antipsychotic drug response, it has become clear that decreased DA activity is present in remitted and chronic states and may relate to deficit symptoms and cortical lesions. In addition, the norepinephrine (NE) system seems to be involved in symptomatology, antipsychotic drug response, course, and outcome in schizophrenia. This review supports the hypothesis that a disturbance in DA and NE activity regulates schizophrenic behavior. A plethora of DA- and NE-related findings in schizophrenic patients are reviewed in relationship to each other according to basic science data and to presently entertained hypotheses, with emphasis on a neural developmental disturbance interacting with a genetic predisposition shaped by environmental factors.