Urinary tract infections in acute psychosis

Krystle L. Graham, Chelsea M. Carson, Amaka Ezeoke, Peter F. Buckley, Brian J. Miller

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective: Schizophrenia is associated with increased infections across the lifespan. We previously found an association between urinary tract infection (UTI) and acute nonaffective psychosis. The aims of this study were to explore further the relationship between UTI and acute psychosis, including associated clinical features. Method: We identified by chart review subjects aged 18 64 years who were hospitalized between January2010 and April 2012 foran acute episode of D5M-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, psychosis not otherwise specified, or delusional disorder; n 134), affective psychosis (bipolar or major depressive disorder with psychotic features; n 101), or alcohol detoxification (n 105), and we recruited healthy controls (n 39). Urinary tract infection was defined as positive leukocyte esterase and/or positive nitrites on urinalysis and >5 10 leukocytes/ high-powered field on urine microscopy. Results:The prevalence of UTI was 21% in nonaffective psychosis, 18% in affective psychosis, 12% in alcohol use disorders, and 3% in controls. After controlling for potential confounders, UTI was almost 11 times more likely in subjects with nonaffective psychosis than controls (OR 10.7; 95% Cl, 1.4 83.2; p .02) and almost 9 times more likely in subjects with major depressive disorder with psychotic features than controls (OR 8.9; 95% Cl, 1.1 71.4;P .04).There were no associations between clinical characteristics and UTI in acute psychosis. Conclusions: We replicated and extended an association between an UTI and acute psychosis. Findings suggest that infections appear relevant to the etiopathophysiology of relapse and increased premature mortality risk in the psychoses.The results also highlight the poteritidl irnportdrice of monitoring for comorbid UTI in relevant patient populations.

Original languageEnglish (US)
Pages (from-to)379-385
Number of pages7
JournalJournal of Clinical Psychiatry
Volume75
Issue number4
DOIs
StatePublished - Apr 2014

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Urinary Tract Infections
Psychotic Disorders
Major Depressive Disorder
Schizophrenia
Alcohols
Psychotic Affective Disorders
Paranoid Schizophrenia
Premature Mortality
Urinalysis
Nitrites
Infection
Bipolar Disorder
Microscopy
Leukocytes
Urine
Recurrence

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Urinary tract infections in acute psychosis. / Graham, Krystle L.; Carson, Chelsea M.; Ezeoke, Amaka; Buckley, Peter F.; Miller, Brian J.

In: Journal of Clinical Psychiatry, Vol. 75, No. 4, 04.2014, p. 379-385.

Research output: Contribution to journalArticle

Graham, Krystle L. ; Carson, Chelsea M. ; Ezeoke, Amaka ; Buckley, Peter F. ; Miller, Brian J. / Urinary tract infections in acute psychosis. In: Journal of Clinical Psychiatry. 2014 ; Vol. 75, No. 4. pp. 379-385.
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abstract = "Objective: Schizophrenia is associated with increased infections across the lifespan. We previously found an association between urinary tract infection (UTI) and acute nonaffective psychosis. The aims of this study were to explore further the relationship between UTI and acute psychosis, including associated clinical features. Method: We identified by chart review subjects aged 18 64 years who were hospitalized between January2010 and April 2012 foran acute episode of D5M-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, psychosis not otherwise specified, or delusional disorder; n 134), affective psychosis (bipolar or major depressive disorder with psychotic features; n 101), or alcohol detoxification (n 105), and we recruited healthy controls (n 39). Urinary tract infection was defined as positive leukocyte esterase and/or positive nitrites on urinalysis and >5 10 leukocytes/ high-powered field on urine microscopy. Results:The prevalence of UTI was 21{\%} in nonaffective psychosis, 18{\%} in affective psychosis, 12{\%} in alcohol use disorders, and 3{\%} in controls. After controlling for potential confounders, UTI was almost 11 times more likely in subjects with nonaffective psychosis than controls (OR 10.7; 95{\%} Cl, 1.4 83.2; p .02) and almost 9 times more likely in subjects with major depressive disorder with psychotic features than controls (OR 8.9; 95{\%} Cl, 1.1 71.4;P .04).There were no associations between clinical characteristics and UTI in acute psychosis. Conclusions: We replicated and extended an association between an UTI and acute psychosis. Findings suggest that infections appear relevant to the etiopathophysiology of relapse and increased premature mortality risk in the psychoses.The results also highlight the poteritidl irnportdrice of monitoring for comorbid UTI in relevant patient populations.",
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N2 - Objective: Schizophrenia is associated with increased infections across the lifespan. We previously found an association between urinary tract infection (UTI) and acute nonaffective psychosis. The aims of this study were to explore further the relationship between UTI and acute psychosis, including associated clinical features. Method: We identified by chart review subjects aged 18 64 years who were hospitalized between January2010 and April 2012 foran acute episode of D5M-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, psychosis not otherwise specified, or delusional disorder; n 134), affective psychosis (bipolar or major depressive disorder with psychotic features; n 101), or alcohol detoxification (n 105), and we recruited healthy controls (n 39). Urinary tract infection was defined as positive leukocyte esterase and/or positive nitrites on urinalysis and >5 10 leukocytes/ high-powered field on urine microscopy. Results:The prevalence of UTI was 21% in nonaffective psychosis, 18% in affective psychosis, 12% in alcohol use disorders, and 3% in controls. After controlling for potential confounders, UTI was almost 11 times more likely in subjects with nonaffective psychosis than controls (OR 10.7; 95% Cl, 1.4 83.2; p .02) and almost 9 times more likely in subjects with major depressive disorder with psychotic features than controls (OR 8.9; 95% Cl, 1.1 71.4;P .04).There were no associations between clinical characteristics and UTI in acute psychosis. Conclusions: We replicated and extended an association between an UTI and acute psychosis. Findings suggest that infections appear relevant to the etiopathophysiology of relapse and increased premature mortality risk in the psychoses.The results also highlight the poteritidl irnportdrice of monitoring for comorbid UTI in relevant patient populations.

AB - Objective: Schizophrenia is associated with increased infections across the lifespan. We previously found an association between urinary tract infection (UTI) and acute nonaffective psychosis. The aims of this study were to explore further the relationship between UTI and acute psychosis, including associated clinical features. Method: We identified by chart review subjects aged 18 64 years who were hospitalized between January2010 and April 2012 foran acute episode of D5M-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, psychosis not otherwise specified, or delusional disorder; n 134), affective psychosis (bipolar or major depressive disorder with psychotic features; n 101), or alcohol detoxification (n 105), and we recruited healthy controls (n 39). Urinary tract infection was defined as positive leukocyte esterase and/or positive nitrites on urinalysis and >5 10 leukocytes/ high-powered field on urine microscopy. Results:The prevalence of UTI was 21% in nonaffective psychosis, 18% in affective psychosis, 12% in alcohol use disorders, and 3% in controls. After controlling for potential confounders, UTI was almost 11 times more likely in subjects with nonaffective psychosis than controls (OR 10.7; 95% Cl, 1.4 83.2; p .02) and almost 9 times more likely in subjects with major depressive disorder with psychotic features than controls (OR 8.9; 95% Cl, 1.1 71.4;P .04).There were no associations between clinical characteristics and UTI in acute psychosis. Conclusions: We replicated and extended an association between an UTI and acute psychosis. Findings suggest that infections appear relevant to the etiopathophysiology of relapse and increased premature mortality risk in the psychoses.The results also highlight the poteritidl irnportdrice of monitoring for comorbid UTI in relevant patient populations.

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