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- Title
Higher orexin-A levels are associated with treatment response to clozapine in patients with schizophrenia: A cross-sectional study.
- Authors
Chen, Po-Yu; Chiu, Chih-Chiang; Chang, Chin-Kuo; Lu, Mong-Liang; Huang, Cho-Yin; Chen, Chun-Hsin; Huang, Ming-Chyi
- Abstract
Background: Clozapine is the primary antipsychotic (APD) for treatment-resistant schizophrenia (TRS). However, only 40% of patients with TRS respond to clozapine, constituting a subgroup of clozapine-resistant patients. Recently, the neuropeptide orexin-A was shown to be involved in the pathophysiology of schizophrenia. This study evaluated the association of orexin-A levels with the clozapine response in patients with TRS. Methods: We recruited 199 patients with schizophrenia, including 37 APD-free and 162 clozapine-treated patients. Clozapine-treated patients were divided into clozapine-responsive (n = 100) and clozapine-resistant (n = 62) groups based on whether they had achieved psychotic remission defined by the 18-item Brief Psychiatric Rating Scale (BPRS-18). We compared blood orexin-A levels among the three groups and performed regression analysis to determine the association of orexin-A level with treatment response in clozapine-treated patients. We also explored the correlation between orexin-A levels and cognitive function, assessed using the CogState Schizophrenia Battery. Results: Clozapine-responsive patients had higher orexin-A levels than clozapine-resistant and APD-free patients. Orexin-A level was the only factor significantly associated with treatment response after adjustment. Orexin-A levels were negatively correlated with BPRS-18 full scale and positive, negative, and general symptoms subscale scores. We also observed a positive correlation between orexin-A levels and verbal memory, visual learning and memory, and working memory function. Conclusions: This cross-sectional study showed that higher levels of orexin-A are associated with treatment response to clozapine in patients with TRS. Future prospective studies examining changes in orexin-A level following clozapine treatment and the potential benefit of augmenting orexin-A signaling are warranted.
- Subjects
OREXINS; PSYCHIATRIC rating scales; CLOZAPINE; PEOPLE with schizophrenia; CROSS-sectional method; VISUAL memory
- Publication
Journal of Psychopharmacology, 2024, Vol 38, Issue 3, p258
- ISSN
0269-8811
- Publication type
Article
- DOI
10.1177/02698811231225610