UTIs Can Really Drive You Crazy

When a person with a known psychotic disorder has an exacerbation of their illness one often tries to determine hear the inciting cause might be. Did the person stop their medications, experience a major life stressor, or use an illicit substance? Is their condition progressing?

A new study identifies a potential cofactors that may have been overlooked: urinary tract infections. 

In a study published in the Journal of Clinical Psychiatry, 21% of those presenting with a psychotic episode who were admitted to the hospital had evidence of a urinary tract infection (as determined by their urinanalysis). By comparison only 3% of controls displayed evidence of infection.

I think that this finding is very intriguing and has the potential to change practice. It is well established that urinary tract infections can induce delirium and exacerbate dementia, so it is not surprising that they may have the same effect in psychotic disorders. Whether the generalized inflammatory response induced by the infection or some other factor is responsible remains to be determined.

At the least, awareness and screening for urinary tract infection should be considered in the evaluation of psychotic patients presenting with worsening symptoms.