Bris.J. Psychiat.(1976), iiz8, 181—3

Serum Creatine Phosphokinase in Acute Psychosis By SOM D. SONI Summary.

Fifty-four

patients

suffering

from

a variety

of psychotic

states

were graded by their degree of psychomotor activity. Serum creatine phospho kinase (CPK) levels were found to be related to the degree of psychomotor activity, irrespective of the diagnostic category. Retarded and withdrawn patients had normal serum CPK, but on their return to normal psychomotor activity the CPK levels tended to rise transiently. It appears that unphysio logical motor activity has a more direct relationship to the rise of serum CPK than motor activity per se.

hrraoDuc'rioN A number

tionship

between

(CPK)

and

acute

had normal serum CPK at all times during

@xMEThOD

of reports

serum

have

indicated

creatine

psychosis

a rela

phosphokinase (i , 2,

4,

6,

7).

Some authors have claimed the rise in CPK to be pathogenetically related to the basic aetiology of acute psychosis (@) and have even suggested it

as

a

diagnostic

parameter

for

psychiatric

disorders (4, g). Acute psychoses are often accompanied by considerable agitation and increased psychomotor activity. This paper reports the preliminary findings of a study relating the changes in serum CPK in acute psychoses to the degree of psychomotor activity. Fifty-four patients, suffering from a variety of psychotic disorders, participated in the study. Diagnoses psychiatric @

their stay in the hospital.

Blood samples were collected between break fast and lunch bi-weekly throughout the stay of the patient in the hospital and estimation of CPK

by the method

of Rosalki

hypothyroidism,

liver

(io).

disease,

RESULTS

The patients showed a wide range of activity, from

marked

retardation

and

withdrawal

in

I3 patients (6 depressive and 7 schizophrenic) through normal activity (8 patients) to severe overactivity, agitation and restlessness in i6 patients (agitated depression @, schizophrenia 7 and mania 4).

ward behaviour, and in particular the amount of psychomotor activity of each patient on a

In all, 18 of the

patients

showed

changes

in serum CPK during their stay in hospital. On

by the groups, in the

admission 9 of the i6 patients with increased psychomotor activity (Grpup C) showed a rise of serum CPK, whereas only 2 from Group B and none from Group A showed a CPK level

present paper: Group A with minimal activity, marked withdrawal and psychomotor retarda tion; Group B with normal activity; and Group C with marked agitation, restlessness and

greater than 100 lU/l. In all but one of the patients with raised levels, the serum CPK fell as the patients recovered and the psychomotor activity subsided (Fig. i). In one patient serum

increased psychomotor activity. These were the patients who were rated on admission as having

@

done

with

encephalopathy, coronary heart disease or a his tory of alcoholism were excluded from the study.

were made by two independent assessors. A chart indicating the

five-point scale, was filled in daily nursing staff on the ward. Only three constituting 37 patients are discussed

was

Patients

CPK

Grades I, 3 and 5 activity respectively (see Table I). The remaining i patients, who showed either Grade 2 or Grade 4 activity,

returned

to

normal

even

though

the

patient remained overactive. In 7 patients with marked initial psychomotor retardation (Table I), 281

an

interesting

phenomenon

was

observed.

182

SERUM CREATINE

PHOSPHOKINASE

ZN ACUTE

workers

400

CPK @.1

and S

200 U

100

is

:

:

:.

.

:

:

0@

..

Time in weeks

—¿

U.

0

in CPK

serum

activity.

. •¿

have

in fact shown

relationship

between

that

there

psychomotor

.

.z:

psychotics

at the time of

clinical recovery is difficult to explain, but it is a finding which has not been observed before.

if. 3

In

relative

terms,

‘¿normal'

activity

on

recovery

may have been excessive and unphysiological when compared to the psychomotor activity 9

4

1

present

levels during

the three-month

activity.

As the patient improved clinically and normal activity returned, the CPK levels rose very transiently above ioo lU/i, to return later to normal levels.

patients

of

during

motor

activity

their need

illness. not

(@, 8), few

nature

ofthe

motor activity

that is of importance

[email protected] I

Group A patients who showed rise ofserum CPK (lU/I)

2nd No.SexDiagnosisOn ActivityI

2

M

Depression

3 4

F M

Depression

5 6

M M

7M

Depression46 FSchizophrenia

0

Depression Schizophrenia Depression

CPK Activity1stweek (IU/l)admission

Activity

@week Activity

2

162

i

192

i69

3 3

92

107

3

76 76

65

I

7! 36 39

I i

151

i

42

i

49i

I6@

62i

Iio@

3rd

i6 62 5023

Psychomotor activity graded on a five-point scale: I. Marked

psychomotor

2. Some psychomotor

retardation

and

be

accompanied by a sustained rise in CPK. Adaptation will occur and serum CPK fall to normal. Thus athletes, who take more exercise than sedentary workers, do not have higher levels of serum CPK. This may be an explanation of

increased psychomotor activity is related to rise of serum CPK, this relationship is complex and not necessarily direct. It is the ‘¿unphysiological'

that the source of raised

serum CPK is the skeletal muscle

in these

Continuation

the case from Group C in which CPK fell despite continued overactivity. This study has thus revealed that, whereas

DISCUSSIONAND CONCLUsIONS the finding

authors

The cause of the transient rise of serum CPK

observation period and their relationship to psychomotor

Despite

some some

levels in some retarded

.

Fio. i.—SerumCPK levels in i6 patientsfromGroup C changes

the raised

to psychomotor

activity in psychoses and the rise in CPK (6, 8).

1

N2 of patientswith grade5 activity_ 16 showing

psychoses

Thepresent study confirms thisrelationship.

•¿

:.

5) @

tried to relate

in acute

Excessive ‘¿unphysiological' activity is almost always accompanied by raised serum CPK (s),

300

E

have

PSYCHOSIS

withdrawal.

retardation.

3. Normal psychomotor activity. 4. Slight increase in psychomotor activity.

5. Marked increase in psychomotor activity with restlessnessand agitation.

@week

3 3

62 59

3 3

3 3

44

3

—¿

3

45

3

346

313

3

BY SOM D. SONI

rather than motor activity per se. Since psycho motor activity appears to be related to the rise of serum CPK, the author feels that estima tion of serum CPK could not possibly be of value in the differential diagnosis of psychiatric disorders (6). One obvious problem in this type of study is the difficulty in quantitating the psychomotor activity. A method of accurately quantitating motor activity, using an EEG machine, has been evolved in this hospital, and work is now in progress for a second study incorporating this method.

183

2. COFFEY,J. W., HEATH, R. G. & Guscisw@re, A. F.

(‘97°)Serum creatine kinase, aldolase and copper in acute and chronic Biological P@ychiasry,2,331-9.

schizophrenia.

3. DUBO, H., P@iuc, D. C., PENNINOTON, R. J. T., KALBAG, R. M. & WALTON, J. N. (i@67)

Serum

creatine

injury

kinase

in cases of stroke,

head

and meningitis. Lances,ii, 743-8. 4. GOSLING, R., Ksiutv, R. J., Oiure,J. E. & OWEN,G. (1972)

Creatine

phosphokinase

activity

in newly

admitted psychiatric patients. British Journal of Psychiatry, 121, 351—5.

5. Giuiivmss, P. D. (i@66) Serum levels OfATP creatine phosphotransferase: the normal range and effect

of muscular activity. ClinicaChimicaAda, 53, 413—20.

6. H@uwmro, T. (‘974) Serum creatine kinase in acute

Acxuowz.anoasszin@

The author wishes to thank the nursing staff and Dr T. J. Rajapaksa for their help and cooperation. His thanks are also extended to Mrs P.JarViS and Mrs C. Bond

for their help in preparationof the paper and to Mr B. Lancaster for allowing the use of the pathological laboratory.

H. & K@ino,

I02—I 2.

8.—

& Mow@ia,R. (1970) Enzymaticactivity after exercise:

study of psychiatric

relatives.

Archives ofGeneral

patients

P@ychiatrj,

and their aa, 390-7.

9. —¿ —¿ (197o) Muscle abnormalities in acute psychoses. ArchivesofGeneralP@hiatrj, 2@,@ç8i-go.

RIPERINGE5 I . BENOZON, A., Hippius,

psychosis. British Journal ofP@ychiatrj, 525, 280-5.

7. MELW.R, H. Y. (i@6@)Muscle enzyme release in acute psychosis. Archivesof GeneralP@ychiatry,as,

H. (i p66)

Some

I0. Ros@ua,

S. B.

(ig67)

An

improved

procedure

change in the serum using psychotropic drugs.

serum creatine

Journal ofXervous and Mental Disease, 143, 369-76.

ofLaborator, and Clinical Medicine, 6g, 696-705.

phosphokinase

estimation.

for

Journal

Som D. Soul, M.D., Ph.D., M.R.C.P., M.R.C.PSYCh., Consultant Psychiatrist, Prestwich Hospital, Prestwich, Manchester, M25 7BL (Received 28 February5975)

Serum creatine phosphokinase in acute psychosis. S D Soni BJP 1976, 128:181-183. Access the most recent version at DOI: 10.1192/bjp.128.2.181

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