Serum and cerebrospinal levels of calcium and magnesium in acute versus remitted schizophrenic patients

A Mini Review on the Various Facets Effecting Brain Delivery of Magnesium and Its Role in Neurological Disorders

Magnesium is an essential cation present in the body that participates in the regulation of various vital body functions. Maintaining normal level of magnesium is essential for proper brain functions by regulating the activities of numerous neurotransmitters and their receptors. Various studies have been reported that magnesium level is found to be declined in both neurological and psychiatric diseases. Declined magnesium level in the brain initiates various cumbersome effects like excitotoxicity, altered blood-brain permeability, oxidative stress, and inflammation, which may further worsen the disease condition. Shreds of evidence from the experimental and clinical studies proved that exogenous administration of magnesium is useful for correcting disease-induced alterations in the brain. But one of the major limiting factors in the use of magnesium for treatment purposes is its poor blood-brain barrier permeability. Various approaches like the administration of its organic salts as pidolate and threonate forms, and the combination with polyethylene glycol or mannitol have been tried to improve its permeability to make magnesium as a suitable drug for different neurological disorders. These results have shown their experimental efficacy in diseased animal models, but studies regarding the safety and efficacy in human subjects are currently underway. We present a comprehensive review on the role of magnesium in the maintenance of normal functioning of the brain and various approaches for improving its BBB permeability.

In Schizophrenia, the Effects of the IL-6/IL-23/Th17 Axis on Health-Related Quality of Life and Disabilities Are Partly Mediated by Generalized Cognitive Decline and the Symptomatome

Schizophrenia patients show increased disabilities and lower quality of life (DisQoL). Nevertheless, there are no data on whether the activation of the interleukin (IL)-6, IL-23, T helper (Th)-17 axis, and lower magnesium and calcium levels impact DisQoL scores. This study recruited 90 patients with schizophrenia (including 40 with deficit schizophrenia) and 40 healthy controls and assessed the World Health Association QoL instrument-Abbreviated version and Sheehan Disability scale, Brief Assessment of Cognition in Schizophrenia (BACS), IL-6, IL-23, IL-17, IL-21, IL-22, tumor necrosis factor (TNF)-α, magnesium and calcium. Regression analyses showed that a large part of the first factor extracted from the physical, psychological, social and environmental HR-QoL and interference with school/work, social life, and home responsibilities was predicted by a generalized cognitive deterioration (G-CoDe) index (a latent vector extracted from BACs scores), and the first vector extracted from various symptom domains ("symptomatome"), whereas the biomarkers had no effects. Partial Least Squares analysis showed that the IL6IL23Th17 axis and magnesium/calcium had highly significant total (indirect + direct) effects on HR-QoL/disabilities, which were mediated by G-CoDe and the symptomatome (a first factor extracted from negative and positive symptoms). The IL6IL23Th17 axis explained 63.1% of the variance in the behavioral-cognitive-psycho-social (BCPS) worsening index a single latent trait extracted from G-CoDe, symptomatome, HR-QoL and disability data. In summary, the BCPS worsening index is partly caused by the neuroimmunotoxic effects of the IL6IL23Th17 axis in subjects with lowered antioxidant defenses (magnesium and calcium), thereby probably damaging the neuronal circuits that may underpin deficit schizophrenia.

The interleukin-6/interleukin-23/T helper 17-axis as a driver of neuro-immune toxicity in the major neurocognitive psychosis or deficit schizophrenia: A precision nomothetic psychiatry analysis

BACKGROUND

Schizophrenia and especially deficit schizophrenia (DSCZ) are characterized by increased activity of neuroimmunotoxic pathways and a generalized cognitive decline (G-CoDe). There is no data on whether the interleukin (IL)-6/IL-23/T helper 17 (IL-6/IL-23/Th17)-axis is more associated with DSCZ than with non-deficit schizophrenia (NDSCZ) and whether changes in this axis are associated with the G-CoDe and the phenome (a factor extracted from all symptom domains) of schizophrenia.

METHODS

This study included 45 DSCZ and 45 NDSCZ patients and 40 controls and delineated whether the IL-6/IL-23/Th17 axis, trace elements (copper, zinc) and ions (magnesium, calcium) are associated with DSCZ, the G-CoDe and the schizophrenia phenome.

RESULTS

Increased plasma IL-23 and IL-6 levels were associated with Th17 upregulation, assessed as a latent vector (LV) extracted from IL-17, IL-21, IL-22, and TNF-α. The IL-6/IL-23/Th17-axis score, as assessed by an LV extracted from IL-23, IL-6, and the Th17 LV, was significantly higher in DSCZ than in NDSCZ and controls. We discovered that 70.7% of the variance in the phenome was explained by the IL-6/IL-23/Th17-axis (positively) and the G-CoDe and IL-10 (both inversely); and that 54.6% of the variance in the G-CoDe was explained by the IL-6/IL-23/Th17 scores (inversely) and magnesium, copper, calcium, and zinc (all positively).

CONCLUSION

The pathogenic IL-6/IL-23/Th17-axis contributes to the generalized neurocognitive deficit and the phenome of schizophrenia, especially that of DSCZ, due to its key role in peripheral inflammation and neuroinflammation and its consequent immunotoxic effects on neuronal circuits. These clinical impairments are more prominent in subjects with lowered IL-10, magnesium, calcium, and zinc.

Beyond the Mind-Serum Trace Element Levels in Schizophrenic Patients: A Systematic Review

The alterations in serum trace element levels are common phenomena observed in patients with different psychiatric conditions such as schizophrenia, autism spectrum disorder, or major depressive disorder. The fluctuations in the trace element concentrations might act as potential diagnostic and prognostic biomarkers of many psychiatric and neurological disorders. This paper aimed to assess the alterations in serum trace element concentrations in patients with a diagnosed schizophrenia. The authors made a systematic review, extracting papers from the PubMed, Web of Science, and Scopus databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Among 5009 articles identified through database searching, 59 of them were assessed for eligibility. Ultimately, 33 articles were included in the qualitative synthesis. This review includes the analysis of serum levels of the following trace elements: iron, nickel, molybdenum, phosphorus, lead, chromium, antimony, uranium, magnesium, aluminum, zinc, copper, selenium, calcium, and manganese. Currently, there is no consistency regarding serum trace element levels in schizophrenic patients. Thus, it cannot be considered as a reliable prognostic or diagnostic marker of schizophrenia. However, it can be assumed that altered concentrations of those elements are crucial regarding the onset and exaggeration of either psychotic or negative symptoms or cognitive dysfunctions.

Association of alkali metals and Alkaline-earth metals with the risk of schizophrenia in a Chinese population: A Case-Control study

Alkali metals (AMs) and alkali earth metals (AEMs) affect levels and signaling of neurotransmitters, which potentially play a role in the etiology of schizophrenia (SCZ). The current case-control study aims to explore how AMs [i.e. Potassium (K), sodium (Na), rubidium (Rb), cesium (Cs)] and AEMs [i.e. magnesium (Mg), calcium (Ca), strontium (Sr), barium (Ba)] in serum could associate with SCZ. One hundred and five inpatients with SCZ and 106 age- and sex-matched healthy controls (HCs) were recruited from Weifang, China. Inductively Coupled Plasma-Atomic Emission Spectrometry (ICP-AES) was used to evaluate serum concentrations of Na, K, Ca, Mg and Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was for Rb, Cs, Sr, Ba. Subjects with SCZ had significantly higher Mg and Sr serum concentrations than HCs (20.86 vs. 19.73 μg/mL of Mg, p < 0.001; 53.14 vs. 42.26 ng/mL of Sr, p < 0.001). After adjusting for confounders, the odds ratio of Mg and Sr remain significantly higher in the SCZ group (Mg: OR = 2.538, 95 % CI: 1.254-5.136, p=0.010; Sr: OR = 3.798, 95 % CI: 1.769-8.153, p = 0.001). No significant differences between SCZ subjects and HCs were observed for other AMs and AEMs. Higher serum concentrations of Mg and Sr were associated with SCZ. Studies are suggested to find the related mechanisms and provide clues for pathogenesis of SCZ, which would impact prevention and treatments of SCZ.

Magnesium in schizophrenia

Many psychopathological symptoms, including schizophrenia, can be associated with magnesium metabolism disturbances. In the literature, contradictory data exist regarding magnesium levels in patients with this disorder. However, this situation might be caused by determination of extracellular concentration of magnesium; although, this is mainly an intracellular ion. There are no data concerning determination of the ionized fraction of magnesium in patients with schizophrenia, while the ionized fraction represents 67% of the total pool of magnesium in healthy people. Also, the mechanism of magnesium action-the effect of magnesium ions on NMDA and GABA receptors-has not yet been fully investigated. There are preliminary studies aimed at increasing the effectiveness of schizophrenia pharmacotherapy via magnesium supplementation. Multidirectional activity of magnesium can significantly increase its therapeutic effect in psychiatry. This observation is confirmed by recent studies conducted by various research teams. However, further studies on the role of magnesium supplementation in patients with schizophrenia are needed.

Platelet and serum calcium and magnesium concentration in suicidal and non-suicidal schizophrenic patients

AIM

The main processes modulated by Ca and involved in the cause of schizophrenia are alteration in the dopamine and glutamate neurotransmitter system. Intracellular effects of Mg-ions are opposite to Ca-ions in competition at K-ion channels, in Na/K-ATP-ase activity, cAMP/cGMP concentration and Ca-ion currents in pre- and postsynaptic membranes. We conducted this research due to the incongruent results on Ca and Mg concentration that have been published until now and to determine platelet Mg concentration in suicidal and non-suicidal schizophrenic patients.

METHODS

A group of schizophrenic patients consisted of 23 patients with attempted suicide (S-SCH) and 48 patients without suicidal behavior (K-SCH) diagnosed according to ICD-10 diagnosis (F20.0) with or without intentional self-harm (X60-X84). The control group (K) included 99 healthy voluntary blood donors. The Mg and Ca concentration in platelets and serum was determined by atomic absorption spectrophotometry on the AAnalyst 200.

RESULTS

Using one-way anova test and manifold application of the Student-Newman-Keuls post-hoc test we established that there were higher concentrations of platelet Mg (μmol/109 platelets) (P=0.009, F=4.89) and lower concentrations of serum Ca (mmol/L) (P<0.001, F=19.18) in the S-SCH group of patients and higher concentrations of platelet Ca/Mg ratio in the K-SCH group of patients (P=0.006, F=5.37).

CONCLUSION

A higher Ca/Mg ratio in the platelets of non-suicidal patients confirms indirect higher Ca concentration. Higher Mg concentration in the platelets of suicidal patients, considered a Ca antagonist, may represent a compensatory attempt to restrain Ca activity.

Serum levels of magnesium in sudden cardiac deaths among people with schizophrenia: hit or miss?

Schizophrenia is a devastating mental disorder, affecting cognitive, emotional, and behavioral conditions, ability to work, social functioning, family stability and self-esteem of the patient. People with schizophrenia show a two to three-fold increased risk to die prematurely than those without schizophrenia. Understanding the mechanisms behind sudden cardiac death in individuals with schizophrenia is a key to prevention. Although different mechanisms may be related, there are clear indications that cardiac abnormalities play a potential role. Some antipsychotics may be associated with cardiovascular adverse events, e.g., QT interval prolongation, metabolic dysfunction, blood pressure and heart rate alterations. Magnesium (Mg) abnormalities may lead to various morphological and functional dysfunctions of the heart and low levels of serum Mg are considered to be at high risk for sudden cardiac death. As low serum Mg is associated with detrimental effects on the heart and that antipsychotic-treated schizophrenia patients frequently affect the heart rate, possibly, these factors together must change the normal functioning of the heart and consequently being able to culminate in a catastrophic event.

Concentration of calcium and magnesium and trace elements (zinc, copper, iron and manganese) in cerebrospinal fluid: a try of a pathophysiological classification

The aim of this study is to analyze the variation of the elements (Ca, Mg, Cu, Fe, Zn and Mn) in normal and pathological CSF and develop a classification basing on the increases in cells and proteins and taking into account these variations. A total of 173 cerebrospinal fluids were analyzed. Of these, 37 fulfilled the criteria of normality and, after clinical exploration, were considered to be healthy (control group). The remaining 136 CSFs (pathological group) belonged to people for whom some neurological pathology had been observed in the clinical exploration and whose CSF analysis presented some abnormality. CSF was extracted by puncture in the lumbar cistern. The analysis of metals was performed by atomic absorption spectrophotometry. The statistical values (mean±standard deviation) obtained for each element analyzed in control group were as follows: Ca (mg/dL): 4.95±0.70; Mg (mg/dL): 2.74±0.10; Cu (μg/dL): 15.70±13.50; Fe (μg/dL): 13.10±3.60; Zn (μg/dL): 17.40±9.50 and Mn (μg/dL): 2.50±0.70. In the pathological CSFs, significant increases were found (p<0.050) in relation to the control group for Ca, Cu, Fe, Zn and Mn in groups with an increase of both cells and proteins. A significant decrease of Mg (p<0.050) was found in the groups with cell and protein increases. Given the results obtained in the different subgroups of the proposed classification, we conclude that it is necessary to further categorize the patients' diagnostics in the different subgroups. This would help to validate the classification.

Associations of serum Ca and Mg levels with mental health in adult women without psychiatric disorders

Several lines of evidence from previous studies suggest that Calcium (Ca) and Magnesium (Mg) may be involved in intracellular and interneuronal processes associated with affective disorders. However, there have been inconsistent results on the effect of Ca and Mg on depressive mood disorder. This cross-sectional study was conducted to determine whether serum Ca and Mg levels, as well as serum Ca/Mg ratio, are associated with mental health in relatively healthy, adult women without psychiatric disorders. One hundred and twelve adult women were recruited from the outpatient clinic in a university hospital setting. Serum Ca and Mg levels were measured and indicators of mental health such as depression, anxiety, and stress were evaluated using two validated questionnaires; the Hospital Anxiety Depression Scale and the Modified Brief Encounter Psychosocial Instrument Stress Scale. After categorizing the serum Ca and Mg levels, and the Ca/Mg ratio into tertiles, the mean scores on each mental health scale were compared using analysis of covariance. The risk of depressive mood disorder according to the tertiles of serum Mg level and serum Ca/Mg ratio was assessed using logistic regression analysis. Women in the middle tertile of serum Ca/Mg ratio had significantly lower scores on depression and stress scales (p = 0.004 and p = 0.007, respectively) and a lower odds ratio (OR) for the risk of depressive mood disorder (OR = 0.31, CI(95%) 0.10-0.93) than those in the highest tertile. The OR for the risk of depressive mood disorder was higher in women in the lowest tertile of serum Mg than in those in the highest tertile (OR = 3.92, CI(95%) 1.11-13.83). Serum Mg level and serum Ca/Mg ratio may be involved in the mechanism for the progression of depressive mood or stress perception in relatively healthy, adult women.

The mineral depletion of foods available to us as a nation (1940-2002)--a review of the 6th Edition of McCance and Widdowson

Over the past 60 years there have been fundamental changes in the quality and quantity of food available to us as a nation. The character, growing method, preparation, source and ultimate presentation of basic staples have changed significantly to the extent that trace elements and micronutrient contents have been severely depleted. This trend, established in a review of the 5th Edition of McCance & Widdowson's The Composition of Foods, is still apparent in this review of the 6th edition of the same work. Concurrently there has been a precipitous change towards convenience and pre-prepared foods containing saturated fats, highly processed meats and refined carbohydrates, often devoid of vital micronutrients yet packed with a cocktail of chemical additives including colourings, flavourings and preservatives. It is proposed that these changes are significant contributors to rising levels of diet-induced ill health. Ongoing research clearly demonstrates a significant relationship between deficiencies in micronutrients and physical and mental ill health.

The influence of some antipsychotics on erythrocyte magnesium and plasma magnesium, calcium, copper and zinc in patients with paranoid schizophrenia

OBJECTIVE

The aim of the study was the investigation of plasma magnesium, calcium, copper and zinc and erythrocyte magnesium levels in patients with paranoid schizophrenia and the influence of the therapy with two antipsychotic drugs (haloperidol and risperidone) on these concentrations.

METHODS

We investigated the influence of treatment with haloperidol and risperidoneon plasma and erythrocyte magnesium and on plasmatic levels of zinc, calcium and copper on hospitalized 56 patients diagnosed with paranoid schizophrenia (DSM IV).

RESULTS

Our data indicate a decrease of erythrocyte magnesium levels in schizophrenic patients (4.82 +/- 3.1 mg/L vs. 59.2 +/- 1.1 mg/L in control group, p < 0.01). The plasma level of magnesium was unchanged (18.9 +/- 2.17 mg/L in schizophrenic patients vs. 18.26 +/- 1.9 mg/L in control group).

CONCLUSIONS

We consider plasma Cu(2+)/erythrocyte Mg(2+) and plasma Cu(2+)/Zn(2+) ratio two important biological markers of the acute paranoid schizophrenia.

Altered adhesion efficiency and fibronectin content in fibroblasts from schizophrenic patients

Cultured fibroblasts from the cutaneous tissue of 16 schizophrenic patients were compared with 16 control cultured fibroblasts from the healthy subjects. The fibroblasts from the schizophrenic patients showed a decreased adhesion efficiency within 30 min after plating compared to that of the control subjects. However, after 90 min, there was no significant difference between the groups, where more than 90% of the cells from both groups had adhesed to the plate. By immunohistochemistry and western blotting using the antibodies against integrin (VLA5), talin, vinculin, fodrin, vimentin, ankyrin, plectin, fibronectin, and focal adhesion kinase (FAK), there was no significant difference in localization and amount between the groups. The amount of fibronectin released into the medium in which the fibroblast had already kept confluency showed no significant difference between the groups. However, the fibronectin content in cell lysate within 48 h after plating was significantly lower in the schizophrenic group.