UTI Screening, Monitoring May Reduce Psychotic Symptoms

http://www.medscape.com/viewarticle/804551

SAN FRANCISCO — Screening and monitoring for comorbid urinary tract infections (UTIs) may be helpful in improving psychotic symptoms in patients with psychosis or a history of psychotic disorders, new research shows.

A study conducted by investigators from Georgia Health Sciences University in Augusta confirmed a previous finding by the same research group that there is a link between an increased prevalence of UTI and acute relapse of nonaffective psychosis. Furthermore, the researchers found that the association appears to extend to patients with affective psychosis.

“It’s important to monitor and screen for UTI in patients with psychotic symptoms or a history of psychotic disorders and treat UTIs to try and see improvement in psychotic symptoms,” Chelsea Bodenheimer, MD, from Georgia Health Sciences University, toldMedscape Medical News.

The findings were presented here at the American Psychiatric Association’s 2013 Annual Meeting.

“Schizophrenia is associated with an increase in infectious disease mortality,” Dr. Bodenheimer explained. “There are some case reports in the literature describing first-episode psychosis patients with comorbid UTI whose symptoms remitted with treatment of the UTI. We’ve seen that as well in our inpatient unit.”

In an earlier study, Dr. Bodenheimer and colleagues found an association between UTI and acute relapse of nonaffective psychosis.

“That study involved 57 patients with schizophrenia and showed a 35% prevalence of UTI,” she said. “This new study replicates those findings in a larger group of patients that also includes patients with nonaffective psychosis.”

Mechanism Still Unclear

The current study included adults aged 18 to 64 years who were hospitalized between January 2010 and July 2012 for an acute relapse of nonaffective (n = 134) or affective (n = 102) psychosis, or for alcohol detoxification (n = 104), as well as healthy control participants (n = 39).

The prevalence of UTI was 21% in patients with nonaffective psychosis, 18% in those with affective psychosis, 13% in patients with alcohol use disorders, and 3% in control individuals.

Compared with control participants, there was a significantly increased prevalence of UTI in patients with nonaffective (P < .01) and affective (P = .03) psychosis, but not in alcohol use disorders (P = .11).

Patients with nonaffective psychosis and a UTI were more likely to have a positive urine drug screen than those without a UTI (P = .03). Otherwise, patients with nonaffective psychosis did not differ with respect to the number of previous hospitalizations, length of stay, family history of schizophrenia, or the prevalence of hallucinations, delusions, suicidal ideation, or homicidal ideation, based on UTI status.

Dr. Bodenheimer and colleagues plan to continue their study of psychosis and UTI and try to tease out what lies behind the apparent association.

“The significance of inflammation in schizophrenia has been described and studied fairly extensively,” she said. “Whether the mechanism is something along the lines of psychotic symptoms causing increased inflammation leading to UTIs or psychotic symptoms leading to poorer self-care and then inflammation and UTIs — that’s where we are looking to go with our research from here.”

The authors report no relevant financial relationships.

The American Psychiatric Association’s 2013 Annual Meeting. Abstract SCR33-1. Presented May 22, 2013.

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