Chelsea M. Carson’s research while affiliated with Augusta University and other places

Objective: Schizophrenia is associated with increased infections. We previously found an association between urinary tract infection (UTI) and acute psychosis in adults. The aims of this study were to 1) evaluate the prevalence of UTI at the time of admission in children and adolescents with non-affective psychosis and psychotic depression versus those with non-psychotic major depressive disorder, and 2) compare demographic and clinical features between children and adolescents with acute psychosis with and without comorbid UTI. Method: We performed a retrospective chart review of 227 subjects ages 10-18 who were hospitalized between 2005 and 2014 for an acute episode of DSM-IV non-affective psychosis (schizophrenia, schizoaffective disorder, psychosis NOS, or delusional disorder; n=80), major depressive disorder (MDD) with psychotic features (n=47); or MDD without psychotic features (n=100). Results: The prevalence of UTI was 20% in non-affective psychosis, 9% in MDD with psychotic features, and 13% in non-psychotic MDD. After controlling for potential confounders, UTI was 3.5 times more likely in subjects with non-affective psychosis than non-psychotic MDD (OR=3.5, 95% CI 1.3-9.2, p=0.01). Subjects with UTI had a higher prevalence of manic symptoms, but otherwise there were no associations between clinical characteristics and UTI in acute psychosis. Conclusions: We found an association between UTIs and children and adolescents with acute non-affective psychosis. The results highlight the potential importance of screening for comorbid UTI in patients with acute psychosis.

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.