2026 ECNP Congress

PS04-4228

Nonspecific inflammatory markers in first-episode psychosis: Clinical relevance and functional correlates

Jovana Petrovic — I. Binic, S. Tosic Golubovic, F. Petrovic · Psychiatry Clinic University Clinical Center Niš, Psychiatry, Nis, Serbia

2026 ECNP Congress

Background

Inflammatory processes have been increasingly implicated in the pathophysiology of psychotic disorders, with most research focusing on cytokine alterations. However, nonspecific inflammatory markers such as C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR) remain relatively understudied in early psychosis, despite their routine availability in clinical practice [1,2]. These markers reflect systemic inflammatory activity and may capture broader biological processes that are not limited to specific immune pathways. Their potential role in first-episode psychosis (FEP), particularly in relation to clinically relevant outcomes, warrants further investigation.

Objectives

This study aimed to evaluate levels of nonspecific inflammatory markers (CRP, fibrinogen, ESR) in drug-naïve patients with FEP compared with healthy controls. Additionally, we sought to examine their associations with aggression and global functioning, with the goal of assessing their clinical relevance and potential utility in routine psychiatric assessment.

Methods

The study included 60 participants: 38 patients experiencing FEP and 22 healthy volunteers matched for age and sex. Blood samples were collected prior to the initiation of pharmacological treatment. CRP, fibrinogen, and ESR were measured using standard laboratory procedures. Clinical assessment included the Positive and Negative Syndrome Scale (PANSS) for symptom severity, the Modified Overt Aggression Scale (MOAS) for aggression, and the Global Assessment of Functioning (GAF) scale for overall functioning. Statistical analyses involved between-group comparisons and correlation analyses to explore relationships between inflammatory markers and clinical variables. Receiver operating characteristic (ROC) analysis was performed to assess the discriminative capacity of these markers.

Results

Among the examined markers, ESR was significantly elevated in patients with FEP compared to healthy controls (p < 0.05), while CRP and fibrinogen did not show significant group differences. ROC analysis indicated modest discriminative ability of ESR in distinguishing patients from controls. Importantly, higher ESR values were associated with lower GAF scores, suggesting a relationship between systemic inflammation and impaired global functioning. In addition, ESR showed a positive association with aggression severity as measured by MOAS, indicating its potential relevance for behavioral dysregulation. CRP and fibrinogen did not demonstrate consistent associations with clinical parameters.

Conclusions

The findings suggest that nonspecific inflammatory markers, particularly ESR, may reflect clinically meaningful aspects of early psychosis. While less specific than cytokine-based measures, these markers are widely accessible and cost-effective, making them attractive candidates for routine use in psychiatric settings. Their association with functional impairment and aggression highlights their potential role in identifying patients with more severe clinical presentations [3,4]. Incorporating such markers into standard assessment protocols may support early risk stratification and contribute to more individualized treatment approaches. Further research is needed to clarify their utility and to explore how they complement more specific immunological measures within an integrated framework of psychosis [5]. This may be particularly relevant in resource-limited settings where advanced immunological testing is not routinely available.

References

  1. Fernandes BS et al. (2016). Peripheral immune biomarkers in schizophrenia. Molecular Psychiatry.
  2. Khandaker GM et al. (2017). Inflammation and immunity in schizophrenia. Lancet Psychiatry.
  3. Miller BJ et al. (2011). Meta-analysis of inflammatory markers in schizophrenia. Biological Psychiatry.
  4. Upthegrove R et al. (2014). Inflammation in first-episode psychosis. Schizophrenia Research.
  5. Mondelli V et al. (2017). Inflammatory mechanisms in early psychosis. Lancet Psychiatry.