RESUMO
Background: With a complex etiology and chronic, disabling evolution, schizophrenia continues to represent a challenge for patients, clinicians, and researchers alike. Recent emphasis in research on finding practical blood-based biomarkers for diagnosis improvement, disease development prediction, and therapeutic response monitoring in schizophrenia, led to studies aiming at elucidating a connection between stress and inflammation markers. Methods: We set here to explore recent literature aiming to understand the connection between cytokines and cortisol level changes in individuals with schizophrenia and their potential relevance as markers of clinical improvement under treatment. A search was completed in Pubmed, Embase, Web of Science, and APAPsycInfo databases with search terms: (cytokines) AND (cortisol) AND (schizophrenia). This provided 43 results from Pubmed, 82 results from Embase, 52 results from Web of Science, and 9 results from APA PsycInfo. After removing articles not fitting the criteria, 13 articles were selected. Results: While all studies included assess cortisol levels in individuals with schizophrenia, most of them included a healthy control group for comparisons there is diversity in the inflammation markers assessed - the most frequent being the IL-2, IL-4, IL-6, IL-8, and TNF-α. Eleven of the 13 studies compare stress and inflammatory markers in individuals with schizophrenia to healthy controls, one study compares two subgroups of patients with schizophrenia, and one study compares pre- and post-measures in the same group of individuals with schizophrenia. Conclusions: The focus of the studies within the topic is diverse. Many of the selected studies found correlations between cortisol and inflammation markers, however, the direction of correlation and inflammatory markers included differed. A variety of mechanisms behind cortisol and immunological changes associated with schizophrenia were considered. Evidence was found in these studies to suggest that biological immune and stress markers may be associated with clinical improvement in participants with schizophrenia, however, the exact mechanisms remain to be determined.
RESUMO
Background: The Covid-19 pandemic brought vaccination to the front of the series of measures implemented to address the chain-reaction outbreaks that continue to cause loss and suffering. In spite of its proven efficacy, a considerable percentage of the population remains hesitant or right-out opposed. A need for informing public health strategies not only in regards to the current pandemic but for future similar developments remains of utmost importance for researchers and clinicians alike, especially when it comes to vulnerable categories of population. Identifying risk factors associated with vaccine hesitancy in the psychiatric population is the aim of this scoping review. Methods: We performed a systematic search on the topic of Covid-19 vaccine hesitancy in relation to psychiatric disorders, using three databases: Medline, PubMed and Embase. Inclusion criteria focused on studies looking at individuals with a psychiatric disorder in the context of the Covid-19 vaccine hesitancy where possible determinant factors were discussed. Results: Fifteen articles out of 219 publications on the topic of Covid 19 vaccine hesitancy met our inclusion criteria for this review. The common findings of these studies recognize the following risk factors for Covid 19 hesitancy: diagnosis of severe mental illness such as schizophrenia, lower socioeconomic status, lower educational level, and young age. Conclusions: Our findings may contribute to the proactive development of educational strategies targeting the psychiatric population in the context of cultural, ethnic, age and gender diversity, in order to safeguard the wellbeing of all when facing pandemic events. Overarching future directions include creating vaccination promotion strategies specific for the psychiatric population.