The investigation of inflammation in drug-naive first-episode mania by measuring ferritin, peripheral inflammatory markers, and their ratios

Objective: Bipolar disorder (BD) is a complex psychiatric disorder with a multifactorial etiology involving both genetic and environmental factors. Increased inflammatory parameters have been shown in previous studies in bipolar disorder. However, it is not known whether ferritin and other inflammatory markers, primarily involved in autoimmune reactions and inflammation, change at the onset of the first episode. We aimed to investigate whether inflammation levels are elevated in the first episode of mania by measuring peripheral inflammatory markers with their ratios and ferritin. Methods: Fifty-six drug-naive individuals experiencing their first episode of mania (FEM) were clinically diagnosed in accordance with DSM-5 criteria. A control cohort (HC) comprising 57 individuals matched with the patients was included in the study. During the evaluation, symptoms were assessed using BPRS (Brief Psychiatric Rating Scale) and YMRS (Young Mania Rating Scale). Blood specimens were obtained from all participants to analyze levels of white blood cells (WBC), neutrophils, monocytes, albumin, ferritin, C-reactive protein (CRP), lymphocytes, and platelets and determine specific protein ratio. Results: Monocyte, Neutrophil-lymphocyte ratio (NLR), Monocyte-lymphocyte ratio (MLR), and neutro-phil–albumin ratio (NAR), values were statistically higher in the patient group than in the control group. A statistically significant positive correlation was found between ferritin values, BPRS, and YMRS scores.It was determined that NLR and NAR ratios predict the severity of the disease. Conclusion: These findings suggest that while inflammation may not be a definitive predictor for BD, it correlates with the disease’s severity.