An exploratory study of immune markers in acute and transient psychosis

•Elevated baseline levels of pro − and anti − inflammatory immune markers in drug naive patients with acute and transient psychotic disorders when compared with age and gender matched healthy controls.•Persistence of pro − inflammatory state even after improvement in psychiatric symptomatology.•Distinct pattern of immune activation when compared to schizophrenia.

The aim of this study was to look into the balance of pro-inflammatory (TNF-α, IL-6) and anti-inflammatory (TGF-β) cytokines and their association with stress, alterations in HPA axis activity and the disease severity in acute psychosis.Socio-demographic and clinical details were collected from 41 in-patients with a diagnosis of Acute and Transient Psychotic Disorder. Holmes and Rahe Stress Scale for stress in the preceding year, and Brief Psychiatric Rating Scale at baseline and follow up (4-12 weeks) for psychopathology were applied. IL-6, TNF-α (pro-inflammatory), TGF-β (anti-inflammatory) and Cortisol (morning and afternoon values) were measured at baseline and follow up.A total of 30 out of 41 cases recruited had follow up data available. The levels of IL-6 (p < 0.001), TNF-α (p < 0.001) and TGF-β (p < 0.001) at baseline were all found to be significantly elevated compared to 42 age and gender matched healthy controls. There was a significant increase in the levels of TNF-α (p = 0.020) and morning levels of cortisol (p = 0.009) and a significant decrease in the levels of TGF-β (p = 0.004) and afternoon levels of cortisol (p = 0.043) from baseline to follow up.This study showed that there was an increased level of both pro and anti-inflammatory cytokines at baseline and a prolonged pro − inflammatory compared to anti − inflammatory response which warrants larger prospective studies and comparative studies to patients with schizophrenia and bipolar disorders.