Impact of psychopharmacotherapy on systemic infl ammatory response markers in psychosomatic patients: A retrospective study

INTRODUCTION. The safety of pharmacotherapy in patients with mental disorders is critical for accurate assessing systemic inflammatory processes. Psychopharmacotherapy may modulate the immune response, potentially masking systemic inflammatory response (SIR) signs in patients with psychosomatic disorders. This phenomenon complicates the differential diagnostic process and the selection of an appropriate treatment strategy.

AIM. To evaluate the effect of pre-admission psychotropic medication use on key markers of systemic inflammatory response (body temperature, leukocytosis, and C-reactive protein (CRP) levels) to enhance the safety of psychotropic pharmacotherapy and optimize therapeutic strategies in hospitalized patients with mental disorders.

MATERIALS AND METHODS. This single-center retrospective study analyzed data from 850 patients hospitalized between January 2024 and March 2025 with suspected infectious complications or decompensation of somatic pathology. Five classes of psychopharmacotherapeutic agents were evaluated: antipsychotics (n=270), antidepressants (n=56), antiepileptics (n=94), anxiolytics (n=15), and antiparkinsonian agents (n=63). Associations with febrile response (<37°C, ≤38°C, >38°C), leukocytosis, and elevated CRP levels were assessed using the Pearson χ² test, Fisher exact test, and the linear-by-linear association test.

RESULTS. No single drug class affected all three markers simultaneously. Antidepressant use was associated with a significant linear trend toward reduced fever severity (p=0.024). Antiepileptic use was associated with a lower incidence of leukocytosis (p=0.039). Polytherapy (use of ≥3 medications) was significantly associated with alterations in leukocyte counts (p=0.008) and CRP levels (p=0.006). Among individual agents, chlorprothixene and chlorpromazine were associated with higher, while risperidone was associated with lower, SIR parameter values. CRP levels remained consistently elevated and were not influenced by psychotropic medication use.

CONCLUSIONS. Pre-admission psychopharmacotherapy does not uniformly affect all SIR markers. Its effects are selective and most pronounced in the context of polytherapy. C-reactive protein confirmed its status as the most reliable inflammatory marker in this clinical setting. The identified associations support the importance of a personalized approach to treatment selection.

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