Title:The Role of Total White Blood Cell Count in Antipsychotic Treatment for
Patients with Schizophrenia
Volume: 22
Issue: 1
Author(s): Yamin Zhang, Shiwan Tao, Jeremy Coid, Wei Wei, Qiang Wang, Weihua Yue, Hao Yan, Liwen Tan, Qi Chen, Guigang Yang, Tianlan Lu, Lifang Wang, Fuquan Zhang, Jianli Yang, Keqing Li, Luxian Lv, Qingrong Tan, Hongyan Zhang, Xin Ma, Fude Yang, Lingjiang Li, Chuanyue Wang, Liansheng Zhao, Wei Deng, Wanjun Guo, Xiaohong Ma, Dai Zhang and Tao Li*
Affiliation:
- Department of Neurobiology and Affiliated Mental Health Center, Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain
Science and Brain-Machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University,
Hangzhou, Zhejiang, China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou, China
Keywords:
Schizophrenia, antipsychotics, white blood cell, inflammation, drug response, metabolic alterations.
Abstract:
Background: Total white blood cell count (TWBCc), an index of chronic and low-grade
inflammation, is associated with clinical symptoms and metabolic alterations in patients with schizophrenia.
The effect of antipsychotics on TWBCc, predictive values of TWBCc for drug response, and
role of metabolic alterations require further study.
Methods: Patients with schizophrenia were randomized to monotherapy with risperidone, olanzapine,
quetiapine, aripiprazole, ziprasidone, perphenazine or haloperidol in a 6-week pharmacological trial.
We repeatedly measured clinical symptoms, TWBCc, and metabolic measures (body mass index,
blood pressure, waist circumference, fasting blood lipids and glucose). We used mixed-effect linear
regression models to test whether TWBCc can predict drug response. Mediation analysis to investigate
metabolic alteration effects on drug response.
Results: At baseline, TWBCc was higher among patients previously medicated. After treatment with
risperidone, olanzapine, quetiapine, perphenazine, and haloperidol, TWBCc decreased significantly (p
< 0.05). Lower baseline TWBCc predicted greater reductions in Positive and Negative Syndrome
Scale (PANSS) total and negative scores over time (p < 0.05). We found significant mediation of
TWBCc for effects of waist circumference, fasting low-density lipoprotein cholesterol, and glucose on
reductions in PANSS total scores and PANSS negative subscale scores (p < 0.05).
Conclusion: TWBCc is affected by certain antipsychotics among patients with schizophrenia, with
decreases observed following short-term, but increases following long-term treatment. TWBCc is predictive
of drug response, with lower TWBCc predicting better responses to antipsychotics. It also mediates
the effects of certain metabolic measures on improvement of negative symptoms. This indicates
that the metabolic state may affect clinical manifestations through inflammation.
