Graham Krystle L, Carson Chelsea M, Ezeoke Amaka, Buckley Peter F, Miller Brian J
Department of Psychiatry and Health Behavior, Georgia Regents University.
J Clin Psychiatry. 2014 Apr;75(4):379-85. doi: 10.4088/JCP.13m08469.
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.
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.
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.
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.
精神分裂症在其整个病程中与感染增加相关。我们之前发现尿路感染（UTI）与急性非情感性精神病之间存在关联。本研究的目的是进一步探究UTI与急性精神病之间的关系，包括相关的临床特征。
我们通过病历审查确定了年龄在18至64岁之间的受试者，这些受试者在2010年1月至2012年4月期间因DSM-IV非情感性精神病（精神分裂症、分裂情感性障碍、未另行说明的精神病或妄想障碍；n = 134）、情感性精神病（伴有精神病性特征的双相或重度抑郁症；n = 101）或酒精戒断（n = 105）而住院，并招募了健康对照者（n = 39）。尿路感染的定义为尿液分析中白细胞酯酶阳性和/或亚硝酸盐阳性，以及尿液显微镜检查中每高倍视野白细胞≥5 - 10个。
非情感性精神病中UTI的患病率为21%，情感性精神病中为18%，酒精使用障碍中为12%，对照组中为3%。在控制了潜在混杂因素后，非情感性精神病患者发生UTI的可能性几乎是对照组的11倍（OR = 10.7；95% CI，1.4 - 83.2；P =.02），伴有精神病性特征的重度抑郁症患者发生UTI的可能性几乎是对照组的9倍（OR = 8.9；95% CI，1.1 - 71.4；P =.04）。急性精神病的临床特征与UTI之间无关联。
我们重复并扩展了UTI与急性精神病之间的关联。研究结果表明，感染似乎与精神病复发的病因病理生理学以及过早死亡风险增加相关。结果还突出了在相关患者群体中监测合并UTI的潜在重要性。
