C-Reactive Protein and Aggression in Patients with Schizophrenia

Recent studies reported firstly an association between aggression and inflammation and secondly an association between inflammation and schizophrenia. In this study, we aim to explore the association between the clinical signs of schizophrenia, aggressive behavior in patients with relapsing schizophrenia and inflammatory marker: CRP (C-reactive protein). Adult schizophrenia inpatients without affective symptoms (n = 154) were prospectively identified and categorized according to their C-reactive protein measurement at admission as either elevated (CRP > 5 mg/L; n = 52) or normal (CRP < 5 mg/L; n = 102). The following indicators of aggression were compared: PANSS excitement component (PANSS-EC), restraints, injectable treatment and suicidal behavior during hospitalization. Univariate comparisons between elevated and normal CRP levels were performed and multivariate analysis was conducted to control for relevant covariates. Inpatients with elevated C-reactive protein displayed increased aggressive behavior compared to patients with normal CRP levels (<5 mg/L). This was manifested by increased PANSS-EC score (p=0,0001), higher rates of restraint during hospitalization (p=0,0001), higher use of injectable treatment (0,0001) and existence of suicidal behavior (p=0,001). Multivariate analysis revealed that Lymphocyte count, total PANSS score, PANSS excitement score were independently associated with a CRP> 5 mg/L. These results confirm the role played by inflammation and immunity in the appearance of aggressive behavior in schizophrenic patients and highlight the interest of the CRP assay at the admission of patients as an indicator of aggression in hospitalized schizophrenic patients