Recurrent antimicrobial exposure and acute psychosis.

BACKGROUND

There is an increased prevalence of recent antimicrobial exposure in patients with acute psychosis. We previously found recurrent urinary tract infections (UTIs) in some patients with psychosis. We evaluated the prevalence of recurrent antimicrobial exposure in acutely ill inpatients with psychosis.

METHODS

We performed a retrospective chart review of 85 patients age 18 to 65 with multiple hospitalizations for acute psychosis. Antimicrobial exposure was defined as occurring within 3 days of each psychiatric hospitalization. Recurrent infections were defined as antimicrobial exposure during ≥2 separate hospitalizations for acute psychosis.

RESULTS

The prevalence of recurrent antimicrobial exposure was 26% (22/85), including 25% (13/51) in patients with schizophrenia and 26% (9/34) in patients with psychotic mood disorders. Patients with schizophrenia and recurrent antimicrobial exposure were significantly more likely to have visual hallucinations in admissions with infection vs without (31% vs 14%, respectively, P = .04).

CONCLUSIONS

We found that a subset of patients with schizophrenia and psychotic mood disorders has recurrent infections at the time of hospitalization for acute psychosis. Findings replicate an association between recurrent UTIs and acute psychosis. Although the mechanism of this association remains unclear, findings provide additional evidence that infections may be relevant to illness relapse in some patients with psychosis.