Mechanisms of niacin skin test pathogenesis in patients at clinical high risk for psychosis and schizophrenia

Abstract

Introduction. Elevated or imbalanced levels of markers of oxidative stress and inflammation are often observed in various somatic pathologies and mental disorders, including schizophrenia. Purpose of the study. This study aims to investigate the mechanisms of pathogenesis and the evidence supporting the use of niacin skin and oral tests in patients with schizophrenia. Materials and methods. A literature review was conducted on the specific reactions to the niacin skin or oral test in patients with schizophrenia, first-episode psychosis, and those at clinical high risk for psychosis (CHR-P). Evidence-based data up to and including 2024 were reviewed, with 48 literary sources selected. Results. An attenuated niacin-induced flush, coupled with low vitamin B3 levels, an imbalance in the Redox-Ratio and omega-3/omega-6 fatty acids, and elevated phospholipase A2 levels, are the main evidence-based findings associated with schizophrenia. Conclusions. The niacin skin and oral tests in patients with schizophrenia and those at high risk for psychosis are characterized by an abnormal response to niacin. Additional markers may further validate positive test results for niacin.