Innate immunity has been linked to initiation of Alzheimer's disease and multiple sclerosis. Moreover, risk of first-episode psychosis (FEP) and schizophrenia (Sz) is increased after various infections in predisposed individuals. Thus, we hypothesized an analogous role of innate immunity with increased C-reactive protein (CRP) in non-affective psychosis. Differential blood count, CRP, neutrophil and monocyte-macrophage activation markers, cortisol and psychotic symptoms (Positive and Negative Syndrome Scale [PANSS]) were assessed in controls (n = 294) and acutely ill unmedicated FEP (n = 129) and Sz (n = 124) patients at baseline and after 6 weeks treatment. Neutrophils, monocytes, and CRP were increased in patients vs controls at baseline (P < .001), and neutrophil and monocyte counts correlated positively with activation markers. Eosinophils were lower at baseline in FEP (P < .001) and Sz (P = .021) vs controls. Differences in neutrophils (P = .023), eosinophils (P < .001), and CRP (P < .001) were also present when controlling for smoking and cortisol, and partially remitted after antipsychotic treatment. FEP patients with high neutrophils (P = .048) or monocytes (P = .021) had higher PANSS-P scores at baseline but similar disease course. CRP correlated with PANSS-P at baseline (ρ = 0.204, P = .012). Improvement of positive symptoms after treatment correlated with declining neutrophils (ρ = 0.186, P = .015) or CRP (ρ = 0.237, P = .002) and rising eosinophils (ρ = -0.161, P = .036). In FEP, normalization of neutrophils (ρ = -0.231, P = .029) and eosinophils (ρ = 0.209, P = .048) correlated with drug dosage. In conclusion, innate immune system activation correlated with PANSS-P, supporting the immune hypothesis of psychosis. Neutrophil and monocyte counts and CRP levels may be useful markers of disease acuity, severity, and treatment response.

中文翻译：

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急性初发性精神病和精神分裂症的先天免疫细胞和C反应蛋白：与心理病理学和治疗的关系。

先天免疫与阿尔茨海默氏病和多发性硬化症的发生有关。此外，在易感人群中发生各种感染后，首次发作性精神病（FEP）和精神分裂症（Sz）的风险增加。因此，我们假设在非情感性精神病中先天性免疫与C反应蛋白（CRP）升高具有相似的作用。在对照组（n = 294）和急性病未用药的FEP（n = 129）和Sz（n = 129）中评估了差异血细胞计数，CRP，中性粒细胞和单核细胞巨噬细胞激活标志物，皮质醇和精神病性症状（阳性和阴性综合征量表[PANSS]）。 n = 124）基线时和治疗6周后的患者。基线时，患者中性粒细胞，单核细胞和CRP较对照组增加（P <.001），并且中性粒细胞和单核细胞计数与激活标记呈正相关。与对照组相比，FEP（P <.001）和Sz（P = .021）基线时嗜酸性粒细胞较低。在控制吸烟和皮质醇时，嗜中性粒细胞（P = .023），嗜酸性粒细胞（P <.001）和CRP（P <.001）的差异也存在，并且在抗精神病药物治疗后可以部分缓解。高嗜中性粒细胞（P = .048）或单核细胞（P = .021）的FEP患者在基线时具有较高的PANSS-P评分，但病程相似。在基线时，CRP与PANSS-P相关（ρ= 0.204，P = 0.012）。治疗后阳性症状的改善与中性粒细胞下降（ρ= 0.186，P = .015）或CRP（ρ= 0.237，P = .002）和嗜酸性粒细胞增多（ρ= -0.161，P = .036）有关。在FEP中，中性粒细胞（ρ= -0.231，P = .029）和嗜酸性粒细胞（ρ= 0.209，P = .048）的正常化与药物剂量相关。综上所述，先天性免疫系统激活与PANSS-P相关，支持精神病的免疫假设。中性粒细胞和单核细胞计数以及CRP水平可能是疾病敏锐度，严重程度和治疗反应的有用标志。