A Perspective on a Possible Relation Between the Psychopathology of the Schizophrenia/Schizoaffective Spectrum and Unconjugated Bilirubin: A Longitudinal Protocol Study

The associations of psychopathology and metabolic parameters with serum bilirubin levels in patients with acute-episode and drug-free schizophrenia: a 5-year retrospective study using an electronic medical record system

BACKGROUND

The oxidative system plays an important role in the pathogenesis of schizophrenia. Inconsistent associations were found between hyperbilirubinemia and psychopathology as well as glycolipid metabolism in patients with schizophrenia at different episodes. This current study aimed to examine these associations in patients with acute-episode and drug-free (AEDF) schizophrenia.

METHODS

This is a retrospective study using 5 years of data from May 2017 to May 2022 extracted from the electronic medical record system of Chaohu Hospital of Anhui Medical University. Healthy controls (HCs) from the local medical screening center during the same period were also included. Participants' data of the bilirubin levels [total bilirubin (TB), conjugated bilirubin (CB), unconjugated bilirubin (UCB)], glycolipid metabolic parameters and the score of the Brief Psychiatric Rating Scale (BPRS) were collected.

RESULTS

A total of 1468 case records were identified through the initial search. After screening, 89 AEDF patients and 100 HCs were included. Compared with HCs, patients had a higher CB level, and lower levels of glycolipid metabolic parameters excluding high density lipoprotein-cholesterol (HDL-C) (all P < 0.001). Binary logistic regression analyses revealed that high bilirubin levels in the patients were independently associated with higher total and resistance subscale scores of BPRS, a higher HDL-C level, and lower total cholesterol and triglyceride levels (all P < 0.05).

CONCLUSION

Bilirubin levels are elevated in patients with AEDF schizophrenia. Patients with high bilirubin levels have more severe psychopathology and relatively optimized glycolipid metabolism. In clinical practice, regular monitoring of bilirubin levels in this patient population should be carried out.

Temporal Stability of the Dynamic Resting-State Functional Brain Network: Current Measures, Clinical Research Progress, and Future Perspectives

Based on functional magnetic resonance imaging and multilayer dynamic network model, the brain network’s quantified temporal stability has shown potential in predicting altered brain functions. This manuscript aims to summarize current knowledge, clinical research progress, and future perspectives on brain network’s temporal stability. There are a variety of widely used measures of temporal stability such as the variance/standard deviation of dynamic functional connectivity strengths, the temporal variability, the flexibility (switching rate), and the temporal clustering coefficient, while there is no consensus to date which measure is the best. The temporal stability of brain networks may be associated with several factors such as sex, age, cognitive functions, head motion, circadian rhythm, and data preprocessing/analyzing strategies, which should be considered in clinical studies. Multiple common psychiatric disorders such as schizophrenia, major depressive disorder, and bipolar disorder have been found to be related to altered temporal stability, especially during the resting state; generally, both excessively decreased and increased temporal stabilities were thought to reflect disorder-related brain dysfunctions. However, the measures of temporal stability are still far from applications in clinical diagnoses for neuropsychiatric disorders partly because of the divergent results. Further studies with larger samples and in transdiagnostic (including schizoaffective disorder) subjects are warranted.

Clinical profile in schizophrenia and schizoaffective spectrum: relation with unconjugated bilirubin in a prospective and controlled study with psychopathological and psychosocial variables

OBJECTIVE

Our objective was to assess unconjugated bilirubin (UCB) as biomarker for schizophrenia (SCZ) and schizoaffective (SAF) spectrums disorder (relapse vs. partial remission).

METHODS

Eighty-eight psychotic patients completed first assessment during relapse at ward admission, half with SCZ and half with SAF disorder. Forty-four acute bipolar patients were used as controls. After 12-month follow-up, we collected longitudinal protocol (laboratory, psychopathological, and psychosocial data) from 60 patients, half with SCZ and half with SAF disorder.

RESULTS

During psychotic relapse (N = 88), we found a statistically significant difference (analysis of variance [ANOVA]; p = .002), confirmed after post hoc multiple comparisons (Bonferroni) between SCZ (N = 44) and both SAF (N = 44; p = .05) and bipolar controls (N = 44; p = .05); a positive correlation (Pearson's r = .314) between UCB mean levels and Personal and Social Performance item (d) "disturbing and aggressive behaviors"; and a positive correlation (R2 = .223), with statistically significance (p = .008), between UCB mean levels and mean length of stay at the psychiatric ward in SAF patients who completed full protocol (N = 30). During partial remission (N = 60) we found: a statistically significant difference (ANOVA; p = .006), confirmed after post hoc multiple comparisons (Bonferroni) between SCZ (N = 30) and SAF (N = 30; p = .05); plus a negative correlation (Pearson's r = -.399) between UCB mean levels and Positive and Negative Syndrome Scale item G7 "psychomotor retardation." Comparing first and second assessments (paired samples t test) we found a statistically significant difference in UCB mean levels among SAF patients (p = .034).

CONCLUSIONS

There is potential in the research of UCB as a biological marker for SCZ and SAF spectrums disorders during relapse and partial remission of both syndromes.

Acute Psychosis in Withdrawal from Nicotine Vaping in a Young Man with Comorbid Diabetic Ketoacidosis and Cannabis Use

Electronic delivery of nicotine, also termed “vaping,” has a growing evidence base suggesting potential harm through both exposure and withdrawal effects. The current report presents the case of a young man with multiple medical comorbidities, including insulin-dependent diabetes mellitus on an insulin pump and presumed Gilbert’s disease, and chronic cannabis use who experienced acute agitation with hallucinations in the context of quitting his vape pen “cold turkey” or abruptly discontinuing use without a nicotine replacement. While undergoing hospitalization for his complaint of nausea and vomiting in the context of euglycemic diabetic ketoacidosis and cannabis use, his psychotic symptoms became evident and continued until beginning a nicotine replacement patch. A few months later, the patient returned to the hospital again for nausea and vomiting in the context of euglycemic diabetic ketoacidosis and reported cannabis use, however this time without psychosis, and notably after resuming and continuing use of e-cigarette with nicotine replacement delivered on admission. This is the first reported case of acute psychosis related to abrupt vaping withdrawal and adds to the plethora of information regarding potential risks associated with electronic cigarette use.

Unconjugated bilirubin and schizophrenia: a systematic review

Schizophrenia is a complex syndrome of unknown etiology and difficult to manage. Unconjugated bilirubin has been researched as a potential biological marker of this syndrome. The objective of this review article was to gather the studies published to date on the relationship between this molecule and schizophrenia. Broad inclusion criteria have been used (PRISMA) to include as many relevant studies as possible. Fourteen studies were selected: 3 analyzed the effects of unconjugated hyperbilirubinemia in animal models; 6 demonstrated an increased incidence of schizophrenia in patients with increased unconjugated bilirubin; 2 reported an increased incidence of the disease in patients with decreased unconjugated bilirubin; and 3 linked an increased incidence of schizophrenia with an increased excretion of the oxidative product of bilirubin, the so-called biopyrrins. Because of apparently contradictory reported results, the hypothesis that the relationship between schizophrenia and unconjugated bilirubin was not linear and that there was an inflammatory dysfunction explaining this was considered. The 2 most accepted models for the pathophysiology of schizophrenia are described, and the possible role of the molecule in each is clarified. The bilirubin buffer system and its role in antioxidant defense was explored. The average levels of unconjugated bilirubin in patients with schizophrenia, schizoaffective disorder, and bipolar disorder were also compared, having been hypothesized that these diseases could be different points of a same pathological spectrum. Finally, it was concluded that unconjugated bilirubin is a promising molecule that could be used as a possible biological marker for schizophrenia, and the necessity of subsequent efforts for its research was considered.

Unconjugated bilirubin and acute psychosis: a five years retrospective observational and controlled study in patients with schizophrenia, schizoaffective and bipolar disorders

Introduction: Unconjugated bilirubin (UCB) high levels have been correlated with schizophrenia spectrum disorders.Methods: We searched for correlation between UCB mean levels, duration of psychiatric admission, and diagnosis in 255 individuals, including 56 healthy controls and 199 acute patients (namely 44 with schizophrenia, 99 with schizoaffective disorder and 56 with bipolar disorder).Results: We found a statistically significant difference between UCB mean levels of patients with schizophrenia versus patients with schizoaffective (0.41 mg/dL vs. 0.34 mg/dL; p < .03) and bipolar disorders (0,41 mg/dL vs. 0.29mg/dL; p < .0001). We also found a statistically significant difference between UCB mean levels of patients with schizoaffective disorder and bipolar disorder (0.34 mg/dL vs. 0.28; p < .04). We also found a significant difference (p < .001) between mean admission duration of schizophrenia (29 days) versus bipolar patients (16 days). Although in a non-significant manner, the schizoaffective group got a mean admission duration value (22 days) right in between the schizophrenia and the bipolar patients.Conclusions: Our results deserve further research to access the role UCB may have in the physiopathology of acute patients with schizophrenia/schizoaffective/bipolar spectrum disorders.KeypointsUnconjugated Bilirubin (UCB) high levels are correlated with acute psychosis.UCB high levels are correlated with duration of psychiatric admission.UCB mean levels of schizophrenic patients are higher than schizoaffective patients.UCB mean levels of schizoaffective patients are higher than bipolar patients.