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   Infections, antibiotic use linked to manic episodes in people with serious   
   mental illness    
   Date:    
   July 20, 2016    
   Source:    
   Johns Hopkins Medicine    
   Summary:    
   In research using patient medical records, investigators report that people   
   with serious mental disorders who were hospitalized for mania were more likely   
   to be on antibiotics to treat active infections than a group of people without   
   a mental disorder.    
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   FULL STORY    
   In research using patient medical records, investigators from Johns Hopkins   
   and Sheppard Pratt Health System report that people with serious mental   
   disorders who were hospitalized for mania were more likely to be on   
   antibiotics to treat active infections    
   than a group of people without a mental disorder.    
      
      
   Although the researchers caution that their study does not suggest cause and   
   effect, they note that it does suggest that an infection, use of antibiotics   
   or other factors that change the body's natural collection of gut and other   
   bacteria may    
   individually or collectively contribute to behavioral changes in some people   
   with mental disorders.    
      
   Their findings, published July 18 in Bipolar Disorders, add to evidence that   
   the body's immune system, the so-called gut brain axis, and the particular   
   bacterial microbiome each person has play an integral part in the ebb and flow   
   of psychiatric symptoms    
   and psychiatric disorders, including bipolar disorder and schizophrenia.    
      
   "More research is needed, but ours suggests that if we can prevent infections   
   and minimize antibiotic treatment in people with mental illness, then we might   
   be able to prevent the occurrence of manic episodes," says Robert Yolken,   
   M.D., the Theodore and    
   Vada Stanley Distinguished Professor of Neurovirology in Pediatrics at the   
   Johns Hopkins University School of Medicine. "This means we should focus on   
   good-quality health care and infection prevention methods for this susceptible   
   population and pay extra    
   attention to such things as flu shots, safe sex practices and urinary tract   
   infections in female patients."    
      
   Yolken says his team's study grew out of an interest in long-observed   
   connections among infections, the microbiome and symptoms of mental illness.   
   For example, numerous studies have shown that experimental alterations in the   
   microbiome of animals can    
   alter their behavior.    
      
   Because antibiotics kill bacteria and can disrupt the makeup of the   
   microbiome, Yolken and his research colleagues looked at records of antibiotic   
   use in patients treated at the Sheppard Pratt -- a psychiatric hospital in   
   Baltimore -- either as an    
   inpatient or day hospital patient. Just over 64 percent of the patients were   
   female, and all were 18 to 65. Two hundred and thirty-four people were   
   hospitalized for mania, 101 for bipolar disorder, 70 for major depression and   
   197 for schizophrenia.    
   Patients taking antibiotics were receiving a wide range of medications,   
   including tetracycline, penicillin, sulfonamide, cephalosporin,    
   luoroquinolone and macrolides for skin, respiratory, urinary tract and mouth   
   infections.    
      
   For comparison, they surveyed 555 healthy controls ruled not to have a mental   
   disorder, including 347 women and 208 men between the ages of 20 and 60, about   
   their current antibiotic use.    
      
   The researchers examined antibiotic usage as an indirect way to measure for   
   the presence of infection. Antibiotic usages were assessed through medical   
   records with the patients and through an interview with participants in the   
   comparison group.    
      
   Of those hospitalized for mania, episodes of heightened energy and   
   overactivity often associated with bipolar disorder -- 18 participants, or 7.7   
   percent, were taking antibiotics, compared to only 1.3 percent of the   
   controls. This represents a more than    
   fivefold increase in the odds of being in the mania group if taking   
   antibiotics. On the other hand, just over 3 percent of people hospitalized for   
   schizophrenia, 4 percent of people hospitalized for bipolar depression and 2.9   
   percent of people    
   hospitalized for major depression were taking antibiotics.    
      
   The researchers investigated whether the site of infection, such as mouth,   
   skin or respiratory system, correlated with hospitalization, and they found   
   that location of the infection didn't seem to matter, although 15 women had   
   urinary tract infections,    
   which didn't occur in any men.    
      
   Yolken says there are several ways that infection and antibiotic use could   
   directly or indirectly impact psychiatric symptoms. Among the possibilities   
   are that systemic inflammation caused by the infection itself may lead to   
   psychiatric symptoms or,    
   alternatively, that antibiotics disrupt the gut's microbiome by killing off   
   "good bacteria," which may also affect the mind by increasing inflammation if   
   more "bad bacteria" are present.    
      
   Yolken says that the research team is currently looking for how these   
   connections might actually work. One study is investigating, for example,   
   whether suppressing inflammation in the gut with probiotics in people with   
   mental illness will reduce the    
   recurrence of manic episodes.    
      
      
   Story Source:    
      
   The above post is reprinted from materials provided by Johns Hopkins Medicine.   
   Note: Content may be edited for style and length.    
      
   Journal Reference:    
      
   Robert Yolken, Maria Adamos, Emily Katsafanas, Sunil Khushalani, Andrea   
   Origoni, Christina Savage, Lucy Schweinfurth, Cassie Stallings, Kevin Sweeney,   
   Faith Dickerson. Individuals hospitalized with acute mania have increased   
   exposure to antimicrobial    
   medications. Bipolar Disorders, 2016; DOI: 10.1111/bdi.12416    
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   Johns Hopkins Medicine. "Infections, antibiotic use linked to manic episodes   
   in people with serious mental illness." ScienceDaily. ScienceDaily, 20 July   
   2016. .    
      
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