Potential use of the topical niacin skin test in early psychosis—a combined approach using optical reflection spectroscopy and a descriptive rating scale

• Published in: Journal of psychiatric research Vol. 37; no. 3; pp. 237 - 247
• Main Authors: Smesny, Stefan, Berger, Gregor, Rosburg, Timm, Riemann, Sven, Riehemann, Stefan, McGorry, Patrick, Sauer, Heinrich
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.2003; Elsevier
• Subjects: Administration, Topical; Adolescent; Adult; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Diagnostic and Statistical Manual of Mental Disorders; Endophenotype; Female; Humans; Male; Medical sciences; Niacin - administration & dosage; Niacin skin test; Optics and Photonics - instrumentation; Prostaglandins - physiology; Psychology. Psychoanalysis. Psychiatry; Psychometrics. Diagnostic aid systems; Psychopathology. Psychiatry; Psychotic Disorders - diagnosis; Psychotic Disorders - drug therapy; Psychotic Disorders - physiopathology; Reflection spectroscopy; Schizophrenia; Skin Tests; Spectrum Analysis - instrumentation; Techniques and methods; Vasodilator Agents - administration & dosage; Schizophrenia; Reflection spectroscopy; Niacin skin test; Endophenotype; Human; Edema; Optical spectrometry; Skin disease; Evaluation scale; Acute; Nicotinic acid; Prediction; Psychometrics; Pyridine derivatives; Psychosis; Reflection spectrometry; Test validation; First episode; Follow up study; Adolescent; Young adult; Schizophreniform disorder; Erythema; Comparative study; Skin test
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/S0022-3956(03)00006-2

The niacin skin phenomenon reflects a prostaglandin (PG) mediated flush and oedema reaction. As PG metabolism is linked to breakdown of membrane lipids, diminished sensitivity to niacin application suggests potential disturbance in membrane phospholipid—arachidonic acid—PG pathways. We aimed to evaluate and quantify topical niacin skin reaction in early psychosis using optical reflection spectroscopy (ORS) and a new descriptive assessment scale integrating time course, redness, and oedema. Niacin skin tests were performed on 25 medicated first-episode psychosis patients fulfilling DSM-IV criteria for schizophreniform psychosis or schizophrenia and on 25 healthy controls. Nicotinic acid was applied in four dilution steps to the subjects inner forearm skin and skin reaction was consecutively assessed using ORS and a seven point rating scale. Both descriptive ratings and spectroscopic measures revealed significant group differences at the lower niacin concentrations (0.001 and 0.0001 M). At higher concentrations (0.01 and 0.1 M) only descriptive ratings were capable to show significant group effects. Data of both methods showed moderate to strong correlation ( r=0.605) as long as the erythema was not affected by the oedema. The data suggest that niacin sensitivity is inversely correlated with negative symptoms. Both methods demonstrate that niacin sensitivity is impaired in a group of first episode psychosis patients and are therefore able to distinguish a subgroup of patients with metabolic impairment. Niacin sensitivity in high risk populations and the specificity of impaired skin response are subjects of further investigation.