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The lipid profile and the hepatic disturbances in patients with schizophrenia
Radu Dumitru Rosoiu
1
, Mihaela Basa
2
, Lilia-Diana Bandrabur
3
, Domnica Mirela
amar!iu
",
Dra!omir #oprean
$
1
"Ovidius" University, the Center for Educational and Professional Counseling,
Constanta, Romania
2
Emergency Military Hosital Constanta, Clinical !a"oratory, Romania
#
$Ovidius" University %aculty of Medicine, Psychiatric Clinic Pala&u Mare Constanta
County Emergency Hosital, Romania
'
Ovidius" University, %aculty of Medicine, (eartment of )iochemistry, Constanta,
Romania
*
"Ovidius" University, %aculty of +atural and ,gricultural -ciences, Constanta,
Romania.
Correspondence address: Rooiu Radu Dumitru
Ovidius University Constana, Romania, Mamaia Boulevard no. 12,
postal code !""#2$
%&mail: radudumitrurosoiu'(mail.com
1
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%BTR%#T
The objective of this study was represented by the evaluation of some
biochemical parameters belonging or related to the lipid metabolism and/or the hepatic
functioning total serum lipids, total cholesterol, LL!cholesterol, "L!cholesterol,
triacylglycerides #T$%&, $'T, $LT, L", %%T with the aim of identifying possible
significant (uantitative modifications of these parameters in the case of schi)ophrenia*
+n order to investigate the lipid profile and the possible signs of hepatic
disturbance in patients with schi)ophrenia we have chosen a group of , patients
diagnosed with schi)ophrenia, - males and . females, with ages ranging from /0 to 1,
years old and who received specific antipsychotic medication while being treated in the
2sychiatric 3linic 2ala)u 4are 3onstanta 3ounty 5mergency "ospital* The blood serum
samples were analy)ed using the automatic 6ec7man 3oulter 'ynchron 389 biochemical
analy)er*
There were obtained statistically significant results indicating a decrease of the
"L cholesterol as compared with the normal average values and an increase of the LL
cholesterol, but these results should be treated with some caution due to the relatively
increased average age of the group of patients #-/ years& which can be in itself a possible
factor that could influence these modifications*
The results for $'T, $LT and L" were also compared with those found for
these mar7ers in a previous research and published in an article in :00; #/&* The $'T and
$LT increases previously found and reported in the :00; article were not replicated this
time* +n the present research were found slightly decreased values for $'T and $LT
which were also statistically significant and L" changes which were not statistically
significant*
&e' words< schi)ophrenia, hepatic disturbance, total serum lipids, total cholesterol,
LL!cholesterol, "L!cholesterol, triacylglycerides, $'T, $LT, L", %%T
R()M(
3ette =tude avait pour l>objectif d>=valuer (uel(ues param?tres biochimi(ue (ui
appartiennent ou (ui sont li=s au m=tabolisme lipidi(ue et/ou @ la fonction h=pati(ue
lipides totales s=ri(ues, le cholest=rol total, LL cholest=rol, "L cholest=rol, les
triglyc=rides #T$%&, $'T, $LT, L"! dans le but dAidentifier des possibles
modifications (uantitatives significatives dans le cas de la schi)ophr=nie*
2our analyser le profil lipidi(ue et les possibles signes de certaines perturbations
des fonctions h=pati(ues che) les patients schi)ophr?nes, j>ai choisi un groupe de ,
patients diagnosti(u=s avec cette maladie, - hommes et . femmes Bg=s de /0 @ 1, ans et
(ui ont b=n=fici= d>une m=dication sp=cifi(ue antipsychoti(ue @ la 3lini(ue 2sychiatri(ue
2ala)u 4are de la 3lini(ue "ospitali?re =partementale d>Crgence 3onstanta* Les
:
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=chantillons de sang ont =t= analys=s en utilisant l>analyseur 6ec7man 3oulter 'ynchron
389*
L>obtention de r=sultats significatifs statisti(uement indi(ue une baisse de "L
cholest=rol comparable auD valeurs moyennes normales et une hausse de LL!
cholest=rol, mais ces r=sultats doivent Etre pris en compte avec une certaine prudence @
cause de l>Bge moyen asse) =lev= #-/ ans&, facteur (ui aurait pu contribuer @ l>apparition
de ces modifications*
Les r=sultats obtenus pour $'T, $LT et L" ont =t= compar=s @ ceuD obtenus
pour ces mar(ueurs dans une recherche ant=rieure publi=e dans un article en :00;* Les
hausses $'T et $LT observ=es ant=rieurement et publi=es dans l>article de :00; n>ont pas
=t= r=pli(u=es cette fois!ci* ans le cadre de cette recherche on a observ= des faibles
baisses mais significatives statisti(uement de $'T et $LT et des r=sultats non
significatifs statisti(uement pour L" *
Mots-cl*s < m=tabolisme lipidi(ue, fonction h=pati(ue, $'T, $LT, L", LL
cholest=rol, "L cholest=rol*
+,TR-D)#T+-,
'chi)ophrenia is a mental disorder with a compleD etiology characteri)ed by
profound alterations of the entirety of the mental functions, by the decrease of the reality
testing capacity and by a profoundly negative influence over the social insertion of the
individual #1&*
4any different factors are involved in the onset and the manifestation of
schi)ophrenia, among them genetically, neurobiological, psychological and even social
factors, but among all the factors the biological ones seem to be the most important in
this case* This is also the reason that ma7es the schi)ophreniaAs current common
treatment options to be centered on a specific medication, with psychotherapy playing
just a secondary role*
The investigation of the biological roots of schi)ophrenia at the molecular level
concentrated mainly, but not eDclusively, on the neurotransmitter activity and on the
possible genetic factors* 6ut there are many more biological domains that should deserve
and increased attention in this case*
%iven the very important role of lipid compounds in the activity of the cell
membranes, in particular of the neuronal membranes, the investigation of the overall lipid
metabolism could have some utility in the case of a mental disorder with such strong
biological basis as schi)ophrenia* The investigation of liver functioning could also be
e(ually useful in this regard given the very important role played by the liver in the lipid
metabolism*
Fne particular aspect encountered in the study of schi)ophreniaAs biological basis
is the fact that the specific medication of the disorder, namely the typical and atypical
antipsychotics, presents itself some undesirable secondary biological effects that can
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overlap sometimes the effects of the disease and can even be somewhat difficult to be
distinguished from the latter*
-B./#T+0/
The aim of this study was represented by the evaluation of some biochemical
parameters of the lipid metabolism and of the hepatic functioning in patients with
schi)ophrenia total serum lipids, total cholesterol, LL!cholesterol, "L!cholesterol,
triacylglycerides #T$%&, $'T, $LT, L", %%T #-, 1&*

M%T/R+%L %,D M/T1-D
+n order to investigate the lipid profile and the possible signs of hepatic
disturbance in patients with schi)ophrenia we conducted two investigations*
Gor the first investigation, which made the object of a previous article #/&, we
have chosen a group of 11 male patients diagnosed with this particular mental disorder,
with ages ranging from :9 to -1 years old and who received specific antipsychotic
medication while being treated in the 2sychiatric 3linic 2ala)u 4are 3onstanta 3ounty
5mergency "ospital* The blood serum samples were analy)ed using the automatic
6ec7man 3oulter 'ynchron 389 biochemical analy)er, and the variables analy)ed were
$'T, $LT, L" and %%T*
Gor the second investigation, whose results are the main concern for the present
article, we have chosen a group of , patients diagnosed with schi)ophrenia, - males and .
females, with ages ranging from /0 to 1, years old and who received specific
antipsychotic medication while being treated in the 2sychiatric 3linic 2ala)u 4are
3onstanta 3ounty 5mergency "ospital* The blood serum samples were analy)ed also
using the automatic 6ec7man 3oulter 'ynchron 389 biochemical analy)er, and the
variables analy)ed were $'T, $LT, L", total cholesterol, triacylglycerides, "L!
cholesterol, LL!cholesterol and total serum lipids*
The eDperimental data were statistically processed using the Fne sample t!test or
the nonparametric HilcoDon 'igned Ran7 Test, as appropriate to each case, for
determining if the results are statistically significant and using 3ohenAs d for estimating
the effect si)e #a value larger than 0*- meaning a medium si)e of the effect and a value
larger than 0*, a large si)e of the effect&*
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R/)LT %,D D+#)+-,
Gollowing the biochemical analysis we obtained the results summari)ed in the
table and the graphs below<
%nal'te ,ormal ran!e M2D p 3alue #ohen4s d
%T $-"2 +)5l "67312287$12 9:7:1 :76;<:7=
%LT $-": +)5l "27""21$7;"" 9:7:1 172;<:7=
LD1 288-$:: +)5l "6$713218;7$82 9:7:1 :78;<:7$
>>T ;-8" +)5l ";7132873:2 9:7:1 17=$<:7=
Table 1- The results of the first in3esti!ation
%nal'te ,ormal ran!e M2D p 3alue #ohen4s d
%T $-"2 +)5l 1872$2=722 :7:29:7:$ :7==<:7=
%LT $-": +)5l 1$7=;$:287288"1 :7229:7:$ 17:8<:7=
LD1 288-$:: +)5l "1$7=;$:22=7;:16" :726:<:7:$
Total cholesterol 1":-2$: m!5dl 1=1782$2317"86 :7":1<:7:$
Tr'ac'l!l'cerols 8:-18$ m!5dl 18;72$211171=8;= :7":1<:7:$
1DL 26-;1 m!5dl 327"2$:287;13"; 9:7:1 2781<:7=
LDL 2:-13: m!5dl 11$7;$22"7":1:$ :7:129:7:$ 17;$<:7=
Total lipids "::-1::: m!5dl 88$763;$2$87183=" :7$83<:7:$
Table 2 ? The results of the second in3esti!ation
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@i!7 1 ? %T mean 3alues
@i!7 2 ? %LT mean 3alues
1
23.50
49.31
16.25
0
5
10
15
20
25
30
35
40
45
50
Normal mean value First research mean
value
Second research mean
value
AST mean values
22.5
42.44
15.87
0
5
10
15
20
25
30
35
40
45
Normal mean value First research mean value Second research mean
value
ALT mean values
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@i!7 3 ? LD1 mean 3alues
@i!7 " ? >>T indi3idual 3alues for the first research
9
383
495.13
415.88
0
50
100
150
200
250
300
350
400
450
500
Normal mean value First research mean
value
Second research mean
value
LDH mean values

44.0
0
47.0
0
45.0
0
37.0
0
44.0
0
48.0
0
59.0
0
38.0
0
45.0
0
46.0
0
57.0
0
48.0
0
49.0
0
46.0
0
58.0
0
43.0
0
0.0
0
10.0
0
20.0
0
30.0
0
40.0
0
50.0
0
60.0
0
Pa
tie
nt
1
Pa
tie
nt
2
Pa
tie
nt
3
Pa
tie
nt
4
Pa
tie
nt
5
Pa
tie
nt
6
Pa
tie
nt
7
Pa
tie
nt
8
Pa
tie
nt
9
Pa
tie
nt
10
Pa
tie
nt
11
Pa
tie
nt
12
Pa
tie
nt
13
Pa
tie
nt
14
Pa
tie
nt
15
Pa
tie
nt
16
GGT individual values - first research
values situated in the
normal rane
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@i!7 $ ? 1DL indi3idual 3alues for the second research
@i!7 8 ? LDL indi3idual 3alues for the second research
,
3 1 . 5 0
0
2 9 . 5 0
3 6 . 5 0
2 4 . 7 0
4 2 . 8 0
4 0 . 1 0
2 5 . 2 0
2 9 . 1 0
0 . 0 0
5 . 0 0
1 0 . 0 0
1 5 . 0 0
2 0 . 0 0
2 5 . 0 0
3 0 . 0 0
3 5 . 0 0
4 0 . 0 0
4 5 . 0 0
H
D
L
(
m
g
/
d
l
)
P a t i e n t 1 P a t i e n t 2 P a t i e n t 3 P a t i e n t 4 P a t i e n t 5 P a t i e n t 6 P a t i e n t 7 P a t i e n t 8
H D L i n d i v i d u a l v a l u e s - s e c o n d g r o u p i n v e s t i g a t e d
v a l u e s s i t u a t e d i n t h e n o r m a l r a n e
d e c r e a s e d v a l u e s
9 0 . 1 0
0
8 6 . 9 0
1 3 7 . 5 0
1 4 1 . 1 0
1 3 1 . 4 0
1 3 3 . 7 0
8 4 . 6 0
1 2 0 . 7 0
0 . 0 0
2 0 . 0 0
4 0 . 0 0
6 0 . 0 0
8 0 . 0 0
1 0 0 . 0 0
1 2 0 . 0 0
1 4 0 . 0 0
1 6 0 . 0 0
L
D
L
(
m
g
/
d
l
)
P a t i e n t 1 P a t i e n t 2 P a t i e n t 3 P a t i e n t 4 P a t i e n t 5 P a t i e n t 6 P a t i e n t 7 P a t i e n t 8
L D L i n d i v i d u a l v a l u e s - s e c o n d g r o u p i n v e s t i g a t e d
v a l u e s s i t u a t e d i n t h e n o r m a l r a n e
i n c r e a s e d v a l u e s
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+n the first investigation the results obtained for $'T, $LT, L" and %%T were
statistically significant as compared with the normal mean values, with effect si)es
ranging from medium to large and showed overall increases* +n particular four of the
patients in the group presented simultaneously mar7ed increases for $'T, $LT and L"
and very increased values for creatine phospho7inase #not included in this presentation&
#/&, the very large values of 32I being considered as a potential indicator of negative
side effects of the antypsichotic medication that could even cause the neuroleptic
malignant syndrome #'4 +J :000&* 'o the effects of the medication could be counted
as one of the possible factors causing the overall significant statistical results in this
investigation* The results for %%T were overall increased as compared with the normal
average values but all the patients presented values still situated in the normal range #/&*
+n the second investigation we have obtained statistically significant but overall
decreased results for $LT and $'T and for L" the results were not statistically
significant #so in the end, comparing the results obtained in the two investigations, the
results for $LT and $'T were seen to be contradictory, and the results of the first
research not replicated&* The "L and LL values obtained in the second investigation
were significantly higher than the normal values, but for this particular group of patients
the average age was relatively high #-/ years& and it could presumably have a
contribution to the appearance of these results* The results for the total cholesterol,
tryacylglycerides and total lipids didnAt indicate any statistically significant changes as
compared with the normal average values*
Fur research presented in this paper was a part of a bigger effort which targeted a
wider range of biochemical mar7ers, including mar7ers of oDidative stress and
antioDidant defenses, mar7ers of the ammonia metabolism and others biochemical
dysfunctions in schi)ophrenia #:, ., 9&*
#-,#L)+-,
+n the end we can conclude that we feel that the results we have obtained could
indicate the utility of further future investigations aimed at these serum biomar7ers*
These biomar7ers of hepatic function and of lipid metabolism could turn in the end to be
useful either in the further (uest of deciphering schi)ophreniaAs etiology and
mechanisms, either in the further investigation of the psychotropic medicationAs side
effects*
R/@/R/,#/
1& KKK, iagnostic and 'tatistical 4anual of 4ental isorders +J, TeDt Revision,
Gourth 5dition, :000, p* .01*
:& Rosoiu L*, Rosoiu R**, 4ihaiesi 4*, 3ertain 6iochemical 3orrelations of 4ajor
4etabolic Routes in 'chi)ophrenia, $rchives of the 6al7an 4edical Cnion, vol*
/1, no :, pp* -;!1:, #:001&*
;
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.& Rosoiu R*, Rosoiu L*, Mnulescu $*, 3ertain biochemical disfunctions in
schi)ophrenia, $rchives of the 6al7an 4edical Cnion, vol* /:, no* /, pp* :1/!:1;,
#:009&*
/& Rosoiu R**, Jerman +*%*, 6randabur *, 6asa 4*, Rosoiu L, $ntioDidant status
and other biochemical parameters in 'chi)ophrenia, $rchives of the 6al7an
4edical Cnion, vol* //, no*1, pp*;!1/, #:00;&*
-& Rosoiu L*, Jerman +*%*, 6iochimie 3linicM, 5ditura 4untenia, 3onstanNa,
RomBnia #:*00,&*
1& Rosoiu L*, 4etode si tehnici de laborator in biochimie Jol*: ! 6iochimie clinica
#Jaloare diagnostica&, 5d* 58 2FLTF, 3onstanta, Romania, #:010&*
9& Rooiu R**, octoral Thesis, Fvidius Cniversity, 3onstanta, :011*
1