Association between neutrophil to lymphocyte ratio and mood polarity in adolescents admitted to an inpatient psychiatric ward

Abstract

Inflammatory processes are associated with mood disorders, but data on pediatric patients are scarce. The aim of this study was to investigate a possible association between elevated neutrophil/lymphocyte ratio (NLR) -a marker of inflammation and mood polarity (manic/ depressed) in adolescents, admitted between 2010 and 2015 due to a mood disorder episode and to an adolescent inpatient ward. Electronic medical records of 305 patients (aged 10-19 years, 60.6% males) admitted during the study period due to a mood disorder episode were reviewed. Of these, 63 were diagnosed with manic episodes and 242 with depressive episodes. Multivariate analyses were used to compare NLR between and within the two groups, covarying for age, sex, and antipsychotic use. NLR was significantly higher in the manic episode group compared with the depression one. Moreover, in inpatients with multiple hospitalizations, the NLR was higher during their manic episodes than that during their nonmanic states. These results suggest that, as has been reported in adults with bipolar disorder, inflammatory mechanisms may be involved in adolescents' mood disorders as well, particularly in the manic episodes. Thus, clinicians may consider adding anti-inflammatories as part of the treatment of these patients.

Inflammatory Hematological Ratios in Adolescents with Mental Disorders: A Scoping Review

“…Of the remaining publications, 1 was excluded from the review due to the unavailability of the full text. After reviewing the full texts of 24 articles, we included 11 publications in the review [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ]. The main reason for exclusion from analysis was that the studies were ineligible due to the age of the participants ( Figure 1 ).…”

“…All the publications included original studies. Geographically, 6 studies were conducted in Turkey [ 47 , 48 , 49 , 50 , 51 , 52 ], 2 in China [ 53 , 54 ], 2 in Israel [ 55 , 56 ], and 1 in Slovakia [ 46 ]. Six studies examined data from adolescents with affective disorders: 2 studies included patients with bipolar disorder (BD) [ 50 , 52 ], 2 studies included patients with major depressive disorder (MDD) [ 51 , 53 ], 1 study included patients with affective episodes of BD/MDD [ 55 ], and 1 study included patients with various types of affective disorders [ 54 ].…”

“…Geographically, 6 studies were conducted in Turkey [ 47 , 48 , 49 , 50 , 51 , 52 ], 2 in China [ 53 , 54 ], 2 in Israel [ 55 , 56 ], and 1 in Slovakia [ 46 ]. Six studies examined data from adolescents with affective disorders: 2 studies included patients with bipolar disorder (BD) [ 50 , 52 ], 2 studies included patients with major depressive disorder (MDD) [ 51 , 53 ], 1 study included patients with affective episodes of BD/MDD [ 55 ], and 1 study included patients with various types of affective disorders [ 54 ]. One study included adolescents with psychotic disorders [ 56 ]; 1 — obsessive-compulsive disorder (OCD) [ 49 ]; 1 — attention-deficit hyperactivity disorder (ADHD) [ 47 ]; and 1 — substance use disorders (SUD) [ 48 ].…”

“…Four studies [ 53 , 54 , 55 , 56 ] investigated the association between IHRs and certain clinical features of a mental disorder (see Table 2 ). One study demonstrated a statistically significant increase in the systemic immune-inflammation index (SII, the product of platelet and neutrophil counts divided by the lymphocyte count) in adolescents with MDD who had attempted suicide compared with patients with MDD without a history of suicide attempts [ 53 ].…”

Open issues in bipolar and antipsychotic treatments

“…The search for biomarkers in bipolar disorder has been ongoing for a long time, as they could greatly help clinicians with early detection and treatment. The second paper in this issue focuses on neutrophil/lymphocyte ratio and mood polarity in adolescents (Drapisz et al , 2022). Results suggest that in adolescents neutrophil/lymphocyte ratio may be a potential indicator of manic state, a finding that was previously reported in adults (Mazza et al , 2018; Wei et al , 2022).…”