الفهرس 
SCHIZOPHRENIAOnly 14 pages are availabe for public view
Abstract
Schizophrenia is a disorder of the executive function of both sensory and central nervous system (CNS). Although schizophrenia is characterized by a single disease, it is considered as a heterogeneous clinical syndrome affecting one’s thoughts, feeling and acts; the disease is secondary to a dysregulation of neurotrophic factor levels during brain development, which could lead to disorganization of neuronal networks. Inadequate neurotrophic support in the adult brain may decrease its capacity to adapt to changes and increase vulnerability to neurotoxic damage.
Brain-derived neurotrophic factor (BDNF), is a protein which was identified for its role in neuron proliferation, neurogenesis, differentiation and degeneration. BDNF is a member of the neurotrophin family of growth factors which encoded by the BDNF gene. This family of molecules includes nerve growth factor (NGF1), BDNF, glial cell derived neurotrophic factor (GDNF) an finally neurotrophins 3 and 4. This neurotrophic factors are found in the brain as well as in the periphery and this neuropeptide (BDNF) especially has been reported to be involved in long-term potentiation of synaptic strength, a mechanism that is thought to underlie both natural mechanisms that occurs in normal cognitive health beside recovery from mental illness, as well as in adaption and development of mental illness such as schizophrenia BDNF acts on 2 types of receptors TrkB and P75. Activation of TrkB leads to synaptogenesis, neurogenesis and neuron proliferation through 3 different complicated pathways, while activation of P75 leads to programmed cell death and apoptosis.
It has been shown that BDNF mRNA levels are decreased in cortical layers IV and V of the dorsolateral prefrontal cortex of schizophrenic patients, an area that is known to be involved with working memory so it was suggested the linkage between schizophrenia and BDNF.
Antipsychotics are the mainstay of the treatment of schizophrenia, and their potential role in neuroprotection might be related to BDNF However, studies have explored the relationships between several antipsychotic agents and changes in BDNF levels. The true influence of different antipsychotics on change in BDNF levels thus deserves further investigation.
Our study is a cohort study which was conducted on 45 patients with first episode schizophrenia, Patients were diagnosed according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), their severity of symptoms assessed by PANSS (Positive And Negative Syndrome) scale, All patients assessed before starting their medication and after 6 weeks of receiving atypical antipsychotic.
The present study was designed to evaluate the effects of atypical antipsychotics use on serum BDNF levels. We hypothesized that the use of atypical antipsychotics for 6 weeks would increase the serum level of BDNF in patients with first episode schizophrenia.
In the present study the majority of our cases were males with mean age 28.3± 9.7 years ranging from 18 to the eldest 59 years old., The marital status showed that most of them were single, Cases showed almost equal distribution according to educational level where the highest percentage ~27% finished preparatory school, The employment status showed that about 51.1% of them are manual workers The cases came mainly from urban areas ~49%, and The family history for psychiatric illness showed that the most of them 80% didn’t have,
Regarding the clinical subtypes of schizophrenia most of cases were paranoid 73.3%, The mean age of onset of the illness was 27±9.5 years ranging from 17 to 58 years, The mean duration of illness in months was 14.4±6.5 ranging from 7 to 24 months.
The cases were prescribed atypical antipsychotic as follow: 44.4% of the cases were prescribed risperidone, 26.6% were on Olanzapine, 11% were on Quetiapine, 8.8% were on Amisolupride, 4.4% on aripeprazole and 4.4% on Asinapine.
The main findings in our study:
I- In our study we compared
1- Serum BDNF level before and after using of atypical antipsychotic for 6 weeks: found that there was highly statistically significant decrease in the serum BDNF level.
The mean BDNF before treatment was 2.3±1.06 and significantly lowered to 1.5±0.7.
2- We also compared between the effect of each atypical antipsychotic used on BDNF serum level showed that only the Risperidone and Quetiapine showed statistically significant decrease in BDNF level after 6 weeks of therapy.
The level of BDNF before and after treatment in correlation with different atypical antipsychotics showed no statistically significant difference.
3- PANSS score before and after using of atypical antipsychotic for 6 weeks showed that there was highly statistical significant correlation where all scores lowered. The total PANSS score had a mean of 139±13.9 pretreatment and significantly decreased to 84.4±12.7 after 6 weeks of therapy.
4- Between the effect of each atypical antipsychotic used on PANSS score.
The Quetiapine showed the highest mean difference 65.4±13.5 and the Amisulpride showed the least mean difference 43.7±4.9.
The inter group difference showing that there was no statistically significant difference between antipsychotic regarding the total PANSS score.
II- Also in our study we covered important relations between
1. Serum BDNF level of the cases and their Total score of PANSS before starting treatment showing that there is no significant correlation between them which means that no significant correlation between serum BDNF level and severity of the symptoms.
2. Serum BDNF level of the cases and their total (positive, negative and general) PANSS score before starting treatment showing that there is no significant correlation between BDNF serum level and Total positive and general PANSS score but we found negative correlation between BDNF level and negative symptoms.
3. Sociodemographic characteristics of the cases and their serum BDNF level. Showed no statistically significant difference except for the social class evaluation where the middle class showed statistically significant higher mean 3±1.3 compared to high class mean 1.8±0.8 and low social class 2.2±0.8.
4. Clinical profile of the cases and their serum BDNF level.
Suggested that there is no statistically significant differences among different subtypes of schizophrenia in the sample and their BDNF level.
Also there is no statistically significant differences between BDNF serum level pre-treatment and clinical aspect of the illness among cases (age of onset in years and duration of illness in months).
Finally we recommend Replication of the study on a larger sample of patients to ascertain the significance of some results, as some insignificant association may prove to be significant and vice versa, also we recommend further investigations for cognitive, neuropsychological and psychopathological assessment could be useful to clarify the involvement of BDNF in the endophenotype characterization of schizophrenia.