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      Guselkumab for the treatment of severe plaque psoriasis in a schizophrenia patient

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          Abstract

          A wide range of comorbid conditions are associated with psoriasis, many studies have drawn attention to a higher prevalence of psychiatric comorbidities in psoriatic population. Herein, we present a case of a Caucasian 44-years-old man suffering from a severe schizophrenia, who received guselkumab (a human monoclonal antibody targeting the p40 subunit of IL-23) for the treatment of a moderate-to-severe plaque type psoriasis. After 3 months, the patient reached complete resolution of psoriasis without any side effects, maintained at 6 months follow up visit. Some studies have highlighted the hypothesis that an hyperactivation of immune response appears to be one of the main mechanisms underlying the increased risk of this association. In particular, the axis il-17/il-23 plays a central role in the pathogenesis of this disease. Further research will be needed to assess whether anti-IL23 drugs could be a more suitable therapeutic option in psoriatic patients with schizophrenia.

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          A meta-analysis of blood cytokine network alterations in psychiatric patients: comparisons between schizophrenia, bipolar disorder and depression

          D Goldsmith, M H Rapaport, B Miller (2016)
          Schizophrenia, bipolar disorder and major depressive disorder (MDD) have all been associated with aberrant blood cytokine levels; however, neither the pattern of cytokine alterations nor the impact of clinical status have been compared across disorders. We performed a meta-analysis of blood cytokines in acutely and chronically ill patients with these major psychiatric disorders. Articles were identified by searching the PubMed, PsycInfo and Web of Science, and the reference lists of these studies. Sixty-eight studies met the inclusion criteria (40 schizophrenia, 10 bipolar disorder and 18 MDD) for acutely ill patients. Forty-six studies met the inclusion criteria (18 schizophrenia, 16 bipolar disorder and 12 MDD) for chronically ill patients. Levels of two cytokines (interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)), one soluble cytokine receptor (sIL-2R), and one cytokine receptor antagonist (IL-1RA) were significantly increased in acutely ill patients with schizophrenia, bipolar mania and MDD compared with controls (P<0.01). Following treatment of the acute illness, IL-6 levels significantly decreased in both schizophrenia and MDD (P<0.01); sIL-2R levels increased in schizophrenia; and IL-1RA levels in bipolar mania decreased. In chronically ill patients, the levels of IL-6 were significantly increased in schizophrenia, euthymic (but not depressed) bipolar disorder and MDD compared with controls (P<0.01). The levels of IL-1β and sIL-2R were significantly increased in both chronic schizophrenia and euthymic bipolar disorder. Overall, there were similarities in the pattern of cytokine alterations in schizophrenia, bipolar disorder and MDD during acute and chronic phases of illness, raising the possibility of common underlying pathways for immune dysfunction. Effects of treatment on cytokines were more robust for schizophrenia and MDD, but were more frequently studied than for acute mania. These findings have important implications for our understanding of the pathophysiology and treatment of major psychiatric disorders.
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            Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment

            Christoph U. Correll, Nina R Schooler (2020)
            Abstract Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptom constellations. The objective of this review was to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia. Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. The term negative symptoms describes a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal/emotional expression. The negative symptom domain consists of five key constructs: blunted affect, alogia (reduction in quantity of words spoken), avolition (reduced goal-directed activity due to decreased motivation), asociality, and anhedonia (reduced experience of pleasure). Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. While secondary negative symptoms can improve as a consequence of treatment to improve symptoms in other domains (ie, positive symptoms, depressive symptoms or extrapyramidal symptoms), primary negative symptoms generally do not respond well to currently available antipsychotic treatment with dopamine D2 antagonists or partial D2 agonists. Since some patients may lack insight about the presence of negative symptoms, these are generally not the reason that patients seek clinical care, and clinicians should be especially vigilant for their presence. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.
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              Non-Genetic Factors in Schizophrenia

              Simona A. Stilo, Robin Murray (2019)
              Purpose of Review We review recent developments on risk factors in schizophrenia. Recent Findings The way we think about schizophrenia today is profoundly different from the way this illness was seen in the twentieth century. We now know that the etiology of schizophrenia is multifactorial and reflects an interaction between genetic vulnerability and environmental contributors. Environmental risk factors such as pregnancy and birth complications, childhood trauma, migration, social isolation, urbanicity, and substance abuse, alone and in combination, acting at a number of levels over time, influence the individual’s likelihood to develop the disorder. Summary Environmental risk factors together with the identification of a polygenic risk score for schizophrenia, research on gene–environment interaction and environment–environment interaction have hugely increased our knowledge of the disorder.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Dermatol Reports
                Journal ID (publisher-id): DR
                Title: Dermatology Reports
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 2036-7392
                ISSN (Electronic): 2036-7406
                Publication date (Electronic): 23 November 2022
                Publication date Collection: 21 November 2022
                Volume: 14
                Issue: 4
                Electronic Location Identifier: 9476
                Affiliations
                [1 ]Dermatology Unit “D. Innocenzi”, Polo Pontino, Sapienza University of Rome
                [2 ]Department of Human Neuroscience, Sapienza University of Rome
                [3 ]Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome , Latina, Italy
                Author notes
                Dermatology Unit “Daniele Innocenzi”, Dept. of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome – Polo Pontino (LT), Italy. +39.0773.708531 - +39.0773.708399 nicoletta.bernardini@ 123456libero.it

                Contributions: NB (conception); NS (supervision); EP (conception); FM (conception); IP (writer); ET (writer); AM (data collection); GR (data collection); SV (data collection); GB (supervision); CP (supervision).

                Conflict of interest: The authors declare no potential conflict of interest.

                Ethical approval and consent to participate: The patient in this manuscript has given written informed consent to publication of his case details.

                Availability of data and material: Data and materials are available by the authors.

                Publisher's note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

                Article
                DOI: 10.4081/dr.2022.9476
                PMC ID: 9724714
                SO-VID: c01ea803-28e7-4250-828d-016268468693
                Copyright © ©Copyright: the Author(s)
                License:

                This article is distributed under the terms of the Creative Commons Attribution Noncommercial License ( by-nc 4.0) which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

                History
                Date received : 17 January 2022
                Date accepted : 26 January 2022
                Page count
                Figures: 1, Tables: 0, Equations: 0, References: 10, Pages: 2
                Funding
                Funding: None.
                Categories
                Subject: Case Report

                Keywords: guselkumab,psoriasis,schizophrenia
                Data availability:
                Keywords: guselkumab, psoriasis, schizophrenia

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