Global Journal of Medical Research, A: Neurology & Nervous System, Volume 23 Issue 3

treatment adjuvant anti-inflammatory [6] and therefore more reliable in severe mental disorders [10,19]. Many authors cite the hypothesis of frequent inflammation in SZ [6,7,9,10,17,18], both in pathogenesis [7,9] and pathophysiology [18], where the lymphocyte count was lower and that of neutrophils considered higher in schizophrenics patients [7,9,17]. Moreover, a new index, defined as the systemic immune-inflammation index (SII), based on the count of lymphocytes, neutrophils and platelets [13,16,21,22], has been considered a good index [22], and even a better index to reflect local immune response and systemic inflammation, as its high predictive value has been confirmed in a variety of tumors [13,22], brain infarction, cardiovascular disease, and acute pancreatitis [13]. In addition, there may be a connection between anxiety disorders and inflammation, in which the immune system and inflammation play a role. It is suggested the values of NLR [6,23], MLR and PLR are significantly higher in this disorder, even with a limited number of studies [22]. Despite these two independent observations of increased inflammatory markers in SZ and SA, there are no studies, as long we identified, addressing comorbid SZ-SA and checking if the simultaneous SZ-SA diagnosis may reveal increased inflammation. II. O bjective Assess the association between social anxiety (SA) and inflammation in patients diagnosed with schizophrenia (SZ), measuring primarily the NLR, and secondarily the SII, MLR and PLR. III. M ethods It´s about a cross-sectional study of the association between comorbid AS in SZ and levels of peripheral markers of inflammation, especially NLR. The first hypothesis is the increased inflammation (revealed by increased NLR) in patients with comorbid SZ-SA compared to patients with SZ without SA. The second hypothesis is that the other markers (SII, MLR and PLR) are also altered in schizophrenics patients with SA than without SA. The sample comprised 82 patients attending the schizophrenia outpatient clinic of a major teaching hospital in southern Brazil (Hospital de Clínicas de Porto Alegre- HCPA) under the Public Health System, diagnosed with schizophrenia of both genders and aged between 18-70 years. Patients with other psychiatric diagnoses, active or chronic inflammatory or autoimmune diseases, and under treatment with anti- inflammatory or immunosuppressive medication were excluded. All participants were aware of the research objectives and received an invitation to participate. Those who agreed to contribute to the study signed the Informed Consent Form (ICF) approved by the Ethics Committee of the HCPA. Patient´s medical records were also accessed and consulted to ascertain the information needed for the study. a) Instruments Liebowitz Social Anxiety Scale (LSAS): developed in 1987 by Michel Liebowitz and translated, adapted and validated in four languages [23]. It is a 24-item questionnaire that assesses fear/anxiety and avoidance in specific social situations [24] with 11 items related to social interaction and 13 items related to public performance [25]. Four-point scale ranging from 0 = none to 3 = severe, and the total score is obtained by adding the fear and avoidance columns [24,26]. As for the classifications of the scores, there is no consensus in the literature. We based ourselves on the Brazilian study by Dos Santos et al. [23]mentions 32 as a good value for the cut-off point, so we followed the following classification: mild social phobia (32-43 points), moderate (44-81) and severe (from 82 points). Brief Psychiatric Rating Scale (BPRS): developed by Overall and Gorham, is one of the most widely used scales in psychiatric research; where it originally consisted of 16 items, but in 1966 had two additional things (arousal and disorientation), the BPRS-18 [27]. It is a 7-point Likert scale score, where 0 = absent, 1 = normal, 2 = borderline illness, 3 = mild illness, 4 = moderately ill, 5 = markedly ill, 6 = severely ill and 7 = extremely ill. The cut-off score for the remission of schizophrenia on the BPRS-6 was less than 5, while the ranges for mild, moderate, and severe severity were 5- 9, 10-19, and greater than 20, respectively [28]. Some studies address the domains/dimensions of this scale [29-31], we based ourselves on that of Van Dorn et al. [31]for the following classification: positive domain (items ideas of grandeur, distrust, hallucinatory behavior, and altered thought content), negative (affective withdrawal, psychomotor retardation, and blunted affect), affective (somatic worry, anxiety, feelings of guilt, depressed mood, and hostility), and cognitive disorganization (conceptual disorganization, tension, mannerisms and posture, lack of cooperation, excitement, and disorientation). Generalized Anxiety Disorder Scale (GAD-7): is a 4-point Likert scale (0-3) ranging from "never" to "every "day", asking how often the patient was bothered. The index is obtained by summing the scores, with cut-off points 5, 10, and 15 allowing the classification of anxiety into none/normal (0-4), mild (5-9), moderate (10-14), and severe (15-21) [32]. Blood count: through a blood test of the patient, to measure biomarkers of inflammation. The complete blood count is routinely collected at the outpatient clinic and included in patients' charts. Some patients have 36 Year 2023 Global Journal of Medical Research Volume XXIII Issue III Version I ( D ) A © 2023 Global Journals The Link between Social Anxiety and Peripheral Inflammatory Markers in Patients with Schizophrenia Diagnoses