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Urinary Tract Infections in Acute Psychosis

J Clin Psychiatry 2014;75(4):379-385

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 January 2010 and April 2012 for an acute episode of DSM-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% CI, 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% CI, 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 potential importance of monitoring for comorbid UTI in relevant patient populations.

J Clin Psychiatry

Submitted: March 13, 2013; accepted October 24, 2013.

Online ahead of print: January 21, 2014 (doi:10.4088/JCP.13m08469).

Corresponding author: Brian J. Miller, MD, PhD, MPH, Department of Psychiatry and Health Behavior, Georgia Regents University, 997 Saint Sebastian Way, Augusta, GA 30912 (brmiller@gru.edu).