protein gap in psychiatric illness

[bonedrone14]

So I'm used to finding protein gaps pretty regularly in my uncontrolled HIV/hepatitis patients. But I've been working recently with state hospital patients and have noticed that just about every one of them has an elevated protein gap. I've tried to look for literature about this but haven't been able to find anything. None of these people have any of the things I usually work up for an elevated gap. I'm just an intern and am learning some of the theories about depression/bipolar disorder having an inflammatory component...does anyone know if this is all that I'm seeing? Anyone else have any experience seeing this in their patients?

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[clausewitz2]

There is probably at least a subtype of schizophrenia that has an inflammatory component, which is at least one proposed reason why fish oil appears to be helpful in preventing transition from ultra-high-risk prodrome to full psychosis.

 

[splik]

sounds interesting! there is no reason there should a gamma gap in patients with mental disorder. Are you talking about a minor thing or a significant gamma gap? If the latter presumably you are working up by checking HIV and Hep B and C (which of course are common in psych patients), as well as SPEP, UPEP, ESR, and CRP. final consideration is maybe the lab is sketchy!

 

[bonedrone14]

Thanks for your insights! It's definitely not a giant gap...no more than 4.5 or so. Just the consistency from pt to pt is what raised my eyebrows. Maybe it is just the lab. My attending had no idea either.

 

[splik]

4.5 is actually potentially significant! I would definitely work that up assuming not a lab error.

 

[bonedrone14]

I'll definitely have to check over themy again and see. Like you said before it's not out of the realm of possibility for our patients population. Just about everyone gets an HIV and RPR on admit but that leaves a lot of other things still open.

 

[smalltownpsych]

Second hit on google is a case study with a catchy and relevant title. http://www.shmabstracts.com/abstract/always-work-up-a-significant-globulin-gap/

The important point is that our patients with mental illness are at higher risk for missing diagnoses for a variety of reasons and thus it often falls on the psychiatrist to catch these things. Chalk up another reason why it is essential to have psychiatrists.