Altered serum glutathione disulfide levels in acute relapsed schizophrenia are associated with clinical symptoms and response to electroconvulsive therapy.

BACKGROUND

The pathophysiological mechanisms of schizophrenia are complex and not fully elucidated. This study aimed to investigate changes to total glutathione (T-GSH), glutathione disulfide (GSSG), reduced glutathione (GSH), and the GSH/GSSG ratio before and after electroconvulsive therapy (ECT) for patients with acute relapse of schizophrenia and associations with clinical symptoms.

METHODS

The study cohort included 110 patients with acute relapse of schizophrenia and 55 healthy controls. All patients received 8-10 sessions of ECT. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

As compared to the healthy controls, schizophrenia patients had decreased baseline GSSG levels (t = -2.115, p = 0.036) and elevated GSH/GSSG ratios (t = 2.141, p = 0.034). Baseline GSSG levels were negatively correlated with both PANSS total scores (beta = -0.369, t = -4.108, p < 0.001) and positive symptom scores (beta = -0.332, t = -3.730, p < 0.001), while changes to GSSG levels were positively correlated with improvements in PANSS total scores (r = 0.392, p < 0.001) and positive symptom scores (r = 0.293, p = 0.005) after ECT treatment. In treatment responders, GSSG levels were significantly increased (t = -2.817, p = 0.006) and GSH/GSSG ratios were decreased (t = 4.474, p < 0.001), as compared to before ECT, with baseline T-GSH (B = 0.734, OR = 2.083, 95%CI:1.287-3.372, p = 0.003), GSSG (B = -2.720, OR = 0.066, 95%CI:0.011-0.390, p = 0.003), and GSH/GSSG ratio (B = -1.013, OR = 0.363, 95%CI:0.142-0.930, p = 0.035) predictive of clinical improvement.

CONCLUSION

Patients with schizophrenia exhibit significant redox imbalance, and GSSG levels may serve as a potential biomarker to evaluate and predict ECT outcomes.