Inflammation tracks mania course

By Eleanor McDermid, Senior medwireNews Reporter

Markers of inflammation are elevated in patients who are hospitalized for acute mania, a study shows.

Furthermore, persistent elevation of these antibody markers predicted readmission within 6 months of the initial hospitalization, report lead researcher Faith Dickerson (Sheppard Pratt Health System, Baltimore, Maryland, USA) and colleagues in PLoS One.

The team derived an inflammation score from levels of immunoglobulin (Ig)G antibodies to the NR2 peptide fragment of the NMDA receptor, gliadin, and Mason-Pfizer monkey virus protein 24, and IgM antibodies to Toxoplasmagondii.

These antibodies have been linked to mania in previous studies, but Dickerson et al say that “[i]t is the combination of markers that is likely to provide the strongest clinical associations.”

They report that 57 patients with mania had around a threefold increased likelihood for having an inflammation score that was above the 75th or 90th percentile of the score in 207 mentally healthy control participants. The association was independent of age, gender, race, and maternal education.

By contrast, levels were not elevated in 234 patients with multi-episode schizophrenia, 68 with recent-onset psychosis, or 28 who were hospitalized with bipolar depression.

The inflammation score was elevated in mania patients at admission and an average of 4 days into the hospital stay, but 6 months later it had significantly declined, so that patients were still significantly more likely to have scores above the 75th percentile of control scores, but not above the 90th percentile.

“This finding indicates that high levels of immune activation occur in many individuals with mania at the time of hospitalization and subsequently decline,” say the researchers.

They speculate: “This activation could represent an exposure to an exogenous infectious agent, a reactivation of an endogenous agent, or the progression of an autoimmune reaction.”

The inflammation score did not correlate with severity of mania symptoms or with medication. However, it was associated with risk for readmission within 6 months, which occurred for 11 patients. Specifically, having an inflammation score above the 90th percentile of control scores conferred a 7.12-fold increased risk for rehospitalization.

“The current study was meant to be exploratory and to encourage the combination of markers in future investigations,” comment Dickerson et al. “The elucidation of such markers might lead to new methods for predicting and monitoring the clinical course of individuals hospitalized with acute mania and for preventing relapse following hospital discharge.”

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