The Relationship between Tumor Necrosis Factor-Alpha

(Tnf- Α) Serum Level and Negative Scale of PANSS in

Smokin

Schizo

hrenic Batak Men

*Elmeida Effendy

, Mustafa Mahmud Amin

Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan

Keywords Schizophrenia, Tumor Necrosis, PANSS

Abstract:

Chronic schizophrenic patients characterized by non-remitting symptoms and functional decline over time

suggest neuroprogression. Schizophrenia has the aberration in the proportion of immuno-competent cells and

varied cytokine levels, particularly proinflammatory IL-6, IL-1 and TNF-α, in peripheral blood or

cerebrospinal fluid. The negative symptoms of schizophrenia are characterized by deficits in normal emotions

and social functions that can be primary or secondary to the treatment of the disease or other manifestations.

TNF- α plays an important role in developing smoking-related illnesses, chronic obstructive pulmonary

disease (COPD). Inhaling cigarette smoke can cause TNF-α production by alveolar macrophages, which in

turn may increase the production of metalloproteinases (MMPs) involved in the mediation of salmon

inflammation and lung damage. MMPs is involved in the mediation of respiratory inflammation and lung

damage. This study aimed to determine the relationship between serum levels of TNF-α and PANSS negative

scale in men with schizophrenia of Batak tribe smoking. This study was conducted at outpatient instalation

RSJ. Prof. Dr. M. Ildrem Medan in the period of February 2018 - June 2018. This is an analytic numerical

correlation with a cross-sectional approach. Subjects were 50 schizophrenic Batak men. The data analysis

used Spearman correlation. The mean negative scale of PANSS is 30.42 ± 1.691. This shows that there is a

negative symptom in schizophrenic patients. The mean TNF-α serum level was 22.31938 ± 23.242901.

Spearman correlation coefficient between two variables is 0, 403 (p = 0.004). There was a significant

correlation between serum levels of TNF-α and PANSS negative scale with a correlation value of 0.403

showing a positive correlation with moderate correlation strength (r = 0.4 - <0.6).

1 INTRODUCTION

Schizophrenia is a variable clinical syndrome, but

profoundly damaging to psychopathology involving

cognition, emotion, perception, and other aspects of

behavior (Sadock, 2015). The negative symptoms of

schizophrenia are characterized by deficits in normal

emotions and social functions that can be primary or

secondary to the treatment of the disease or other

manifestations (Farokhnia, 2013).

The prevalence of schizophrenia between men

and women is similar, but differs in the onset of the

disorder, is earlier in men than in women. Peak onset

in men between the ages of 10-25 years and 25-35

years in women. Of the 90% of patients receiving

schizophrenic treatment aged between 15-55 years

(Sadock, 2015). The prevalence of schizophrenia in

Batak tribe in BLUD RSJ of North Sumatera

Province is 60%.

The Batak tribe is a group of people known as

Indonesians, with their physical appearance easily

distinguished from Caucasians and blacks (Negroid),

including the Mongoloid group and still actively

practicing customs, especially those domiciled in

North Sumatera Territory (Na, 2007). Batak tribe is

selected because in addition to the prevalence of visits

to polyclinic BLUD RSJ Pemprovsu highest, the

tribe's most awake purity, due to strong customs to

maintain the tribal purity by also marrying with the

Batak tribe.

586

Effendy, E. and Amin, M.

The Relationship between Tumor Necrosis Factor-Alpha (Tnf- ) Serum Level and Negative Scale of PANSS in Smoking Schizophrenic Batak Men.

DOI: 10.5220/0010079605860589

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

586-589

ISBN: 978-989-758-449-7

(Petrescu, 2010) showed that serum TNF-α levels

were significantly higher in the smoker group

compared with the non-smoker group (Petrescu,

2010).

Studies performed by (LV, 2015) showed

significantly lower TNF-α levels in chronic

schizophrenic patients (10.1 ± 2.0 pg / ml) compared

with healthy controls (37.8 ± 3.4 pg / ml) with p

<0.01. Correlation analysis showed a significant

negative correlation between TNF-α levels and total

PANSS score (p <0.01). TNF-α levels were

significantly negative correlated with values in

general psychopathology (p <0.01), positive (p

<0.01), and on the cognitive sub-scale (p <0.05)

(Farokhnia, 2013).

This study wanted to confirm whether there is a

correlation between of TNF-α serum level and

Negative Scale of PANSS in smoking schizophrenic

Batak men.

2 MATERIAL AND METHOD

This is numerical correlative analytic study, with

cross-sectional, which assessed the correlation

between serum levels of TNF-α and Negative Scale

of PANSS in smoking schizophrenic Batak Men.

This study was conducted at the inpatient

installation of Mental Hospital Prof. Dr. M. Ildrem

Medan the period February 2018 - August 2018. The

population was schizophrenic patients, while the

affordable population were schizophrenic patients at

the Inpatient Installation of Mental Hospital Prof. Dr.

M. Ildrem Medan. Sampling method by

Nonprobability sampling type consecutive sampling

that is all subjects that come and meet the eligibility

criteria as much as 50 subjects.

We conduct a mini ICD-10 assessment of the

subject. There was an assessment using PANSS to

assess the negative scale which in this study limited

total score of negative scale PANSS ≥ 21. A total of

5ml of blood samples was taken to all subjects in this

study, of TNF-α serum levels were analyzed using

Quantikine HS Human TNF-α Assay.

Data analysis, before data analysis will be done

data normality test by using the Shapiro-Wilk test

because the number of samples is less than 50.

Furthermore data is analyzed to get correlation value

(r). When the data is normally distributed, it will be

done data analysis using Pearson Correlation test. If

the data is not normally distributed data analysis

using the Spearman correlation test.

3 RESULT

Table 1: Distribution of Subjects Based on Demographic

Characteristics

Variables n %

Age (years)

20-30 8 16

31-40 42 84

Education

Junior high school 28 56

High school 15 30

D3 7 14

Marital Status

Single 14 28

Married 36 72

Duration of illness

2-5 44 88

> 5 6 12

Table 1 shows that the proportion of patients with

schizophrenia is 20-30 years (16%), 31-40 years

(84%). The proportion of schizophrenic patient

education is junior high (56%), high school (30%),

D3 (14%). The proportion of marital status of

schizophrenic patients was unmarried (28%) and

married (72%). Based on the length of illness

schizophrenia patients are 2-5 years (88%) and> 5

years (12%).

Research conducted by (Na, 2007) to see

monocytes, T-helper 1 and T-helper 2 in

schizophrenic patients, they measured TNF-α levels

in schizophrenic and healthy control patients with

The Relationship between Tumor Necrosis Factor-Alpha (Tnf- ) Serum Level and Negative Scale of PANSS in Smoking Schizophrenic

Batak Men

587

mean age and standard deviation is 32.86 ± 12.76 and

31.48 ± 11.83 (Na, 2007).

Particular “confounding“ factors such as age,

smoking, body mass index (BMI), sex, and infection

also have a bearing on levels of IL-6 and TNF-α

(Himmerich, 2009).

Table 2: Mean Negative Scale of PANSS in Schizophrenic

Patients

Variable

Mean SD p

PANSS

Negative

30,42 1.691 0,002

*Shapiro-Wilk test

Table 2. shows that Negative scale of PANSS with

mean of 30,42 and standard deviation 1,691. From the

results of normality test data using Shapiro-Wilk

found p value = 0.002 (p <0.05), so it can be

concluded the data is not normally distributed.

Fan at.el, show serum TNF-α levels showed a

significant negative association with PANSS total

score (r = −0.210, p < 0.01) and negative subscore (r

= −0.300, p < 0.01) (Fan, 2015).

Table 3 : Mean TNF-α serum level in Schizophrenic

Patients

Variable Mean SD p

TNF-α

22.31938 23.24290 0.000

*Shapiro-Wilk test

Table 3. shows that TNF-α is 22.31938 and deviation

standard 23.24290. From the results of normality test

data using Shapiro-Wilk found p value = 0.000 (p

<0.05), so it can be concluded the data is not normally

distributed.

In a study conducted by Theodoropoulou in

Athens showed significantly higher levels of TNF-α

in treatment-treated chronic schizophrenic patients

(26 ± 8 pg / ml) compared with healthy controls (16

± 6 pg / ml) with p <0.001 (Jiang, 2013).

Prior to the correlative test on the baseline data,

firstly tested the normality of data where the variable

of Negative Scale PANSS tested normalization using

Shapiro Wilk Test because the sample amount is less

than or equal to 50 and it is found that the variable of

PANSS Negative Scale Distribution is abnormal

therefore correlative test of baseline data using

Spearman Correlation test.

Table 4 : Correlation Levels of Serum Tumor Necrosis

Factor-Alpha (TNF-α) And Negative Scale PANSS

Levels of Serum Tumor Necrosis Factor –

Alpha

(TNF-α)

Negative Scale PANSS

r = 0,403

p = 0.004

n = 50

*Spearman test

Spearman correlation test serum level Tumor

Necrosis Factor-Alpha (TNF-α) and PANSS

Negative Scale obtained p value <0.05 and concluded

that there is correlation between serum serum Tumor

Necrosis Factor-Alpha (TNF-α) and Negative Scale

PANSS Strength relationship between serum levels

Tumor Necrosis Factor-Alpha (TNF-α) and Negative

Scale PANSS large 0.403 shows a positive

correlation with moderate correlation strength (r = 0.4

-0.6).

4 DISCUSSION

(Al-Asmari, 2014)showed that TNF-α levels in

schizophrenic patients (27.04±4.11) were

significantly higher than normal controls

(17.25±3.20) an imbalance between proinflammatory

and antiinflammatory cytokines may be involved in

the pathophysiology of schizophrenia through

various mechanisms (Asmari, 2014).

The (Petrescu, 2010) study showed a further

increase in serum TNF-α levels in patients with daily

tobacco exposure of more than 1 pack / day. There

was no significant difference between serum TNF-α

levels of nonsmokers and those who smoked less than

1 pack / day. This suggests that active smokers who

cause inflammation usually require a significant

amount of exposure. So based on this study it can be

concluded that heavy smoking can lead to a

significant increase in serum levels of TNF-α and C-

Reactive Protein (CRP), which supports an imbalance

between proinflammatory and antiinflammatory

factors. TNF-α concentrations are elevated in healthy

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

588

serum smokers depending on cigarette doses

(Petrescu, 2010).

Studies performed by Lv kk showed significantly

lower TNF-α levels in chronic schizophrenic patients

(10.1±2.0 pg/ml) compared with healthy controls

(37.8±3.4 pg/ml) with p<0.01. Correlation analysis

showed significant negative correlation between

TNF-α levels and total PANSS score (p<0.01). TNF-

α levels were significantly negative correlated with

values in general psychopathology (p<0.01), positive

(p<0.01). And on the cognitive sub-scale (p<0.05).

Multiple regression analysis gradually identified

TNF-α levels as a significant predictor of general

psychopathology subscale in PANSS (Tan, 2015).

5 CONCLUSIONS

A total of 50 subjects of schizophrenic patients who

participated in the study were in the inpatient

installation of in Mental Hospital Prof. Dr. M. Ildrem

Medan February 2018 – June 2018.

Based on demographic characteristic, it was found

that the subjects of the study were age group 31-40

years (84%), based on the highest level of education

were 28 subjects (56%) junior high school, based on

the highest marital status with marital status of 36

subjects (72%) and based on 2-5 years old sickness of

44 subjects (88%) and> 5 years by 6 subjects (12%).

The average score of PANSS negative scale score in

schizophrenic patients was 30,42±1.691 . The

average serum level of TNF-α in schizophrenic

patients was 22.31938±23.242901. Strength

relationship between serum levels Tumor Necrosis

Factor-Alpha (TNF-α) and PANSS Negative Scale

large 0.403 shows a positive correlation with

moderate correlation strength (r = 0.4-0.6).

ACKNOWLEDGEMENTS

This study was funded by Lembaga Penelitian

Universitas Sumatera Utara Number: 2590/UN5.1.R/

PPM/2018 in talent research program.

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The Relationship between Tumor Necrosis Factor-Alpha (Tnf- ) Serum Level and Negative Scale of PANSS in Smoking Schizophrenic

Batak Men

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