(Aug. 16, 2016) Common respiratory, urinary tract and other infections may play a role in triggering acute mania in bipolar disorder, according to a newly released study.
Based on a sample of 602 individuals hospitalized for symptoms of bipolar disorder and selected other psychiatric conditions, Robert Yolken, MD,* and colleagues found that the patients with acute mania were substantially more likely to be taking antibiotics for infection than patients with schizophrenia or depression and
than non-psychiatric patients.
The authors conclude that patients with a history of mania should be monitored closely for bacterial infections by their healthcare providers and promptly treated with antimicrobial medications when infections develop.
"The control of bacterial infections in individuals with susceptibility to mania and other acute psychiatric conditions might result in the prevention of acute episodes and a marked improvement in their health and well-being," the researchers said.
Infection and Mania, Depression, Schizophrenia
Over the past two years, a growing body of research has examined the possible role of infection and inflammation in causing schizophrenia, bipolar disorder and depression. Previous studies have found the immune system to be activated during acute mania, but the cause of immune activation was not identified.
In "Antimicrobial medications and mania," researchers used the records of antibiotic prescriptions for 1,157 patients hospitalized at Sheppard Pratt Health System in Baltimore to explore the possible role of bacterial infection in activating the immune system in patients with acute mania, bipolar depression, unipolar depression and schizophrenia.
In the study population, 7.7% of the patients with acute mania were found to be prescribed antibiotics. This compared with 1.3% of the non-psychiatric control group. Patients hospitalized with the other three psychiatric conditions also were more likely than the controls to be given antibiotics such as tetracycline or penicillin for infections but at much lower rates than those with acute mania.
The research team identified three possible theories for the association between infection and acute mania:
- Underlying bacterial infection that activates the immune system, which then triggers the onset of mania
- Decreased immunity to infection in bipolar disorder
- Acute mania as a response to the antibiotics themselves
The third theory was considered less likely because many individuals in the study developed mania and were hospitalized before they were diagnosed with infections and given antibiotics.
The study was funded in part by the Stanley Medical Research Institute, a supporting organization of the Treatment Advocacy Center, whose mission includes promoting the development of innovative treatments for and research into the causes of severe and persistent psychiatric diseases.
* Dr. Yolken is a member of the Treatment Advocacy Center board of directors.
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Yolken, Robert et al. (17 July 2016). Individuals hospitalized with acute mania have increased exposure to antimicrobial medications. Bipolar Disorders.
- Research Weekly. (12 January 2016). The growing focus on inflammation in psychiatric research. Treatment Advocacy Center
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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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