Evidence of a Link Between Anemia and Schizophrenia Severity

Researchers discussed relationships between anemia and metabolic biochemical markers in patients with schizophrenia in a poster presented at the American Psychiatric Association 2023 Annual Meeting titled “Anemia and Disease Severity in Schizophrenia. Is There a Connection?”

The authors of the study explored inflammatory markers, lipid profiles, lifestyle variables, and homocysteine levels in schizophrenia to examine the relationship between anemia, cognitive disfunction, and disease severity, and to glean further understanding of the relationships between iron metabolism, chronic inflammation, and schizophrenia.

Researchers noted the prevalence of microcytic anemia in adults with schizophrenia ranged from 2.5% to 4.5% in available evidence, with an odds ratio of 1.90-3.0. However, Alfonso and colleagues found a prevalence of chronic inflammatory iron deficiency of 5.2% within a large schizophrenia cohort. Overall, the authors reported patients with schizophrenia had a prevalence of anemia of 10.8%.

The study included 434 patients with schizophrenia, of whom 300 were men and 134 were women. The cohort had a mean age of 41.8 ± 13.3 years. Patients’ disease severity was evaluated with the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Rating Scale, Global Assessment of Functioning Scale (GAF), and the Screen for Cognitive Impairment in Psychiatry.

Markers for lifestyle habits, metabolic iron status, inflammation, and arteriosclerosis risk were collected and analyzed for associations with hemoglobin levels. Researchers also compared disease severity and cognitive functioning between the groups.

Reportedly, platelet-lymphocyte ratio (PLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), homocysteine, low-density lipoprotein (LDL) cholesterol, triglycerides, and apolipoprotein B (Apo-b) were positively correlated with anemia, while high-density lipoprotein  cholesterol and apolipoprotein A1 (Apo-A1) were negatively correlated.

Patients with anemia had higher PLR, ESR, CRP, homocysteine, LDL cholesterol, triglycerides, Apo-b, and negative PANSS score, whereas patients without anemia had higher GAF and Cognitive Reserve Assessment Scale in Health scores and Apo-A1. Lifestyle habits did not show any significant associations.

In closing, the authors suggested anemia can significantly impact disease severity, cognitive function, risk of arteriosclerosis, and inflammatory markers in patients with schizophrenia. They suggested their study proved “for the first time a relationship between human iron metabolism and the chronic inflammatory status secondary to psychosis.”