Other factors may have contributed to the patient’s improvement, including her medical treatment (eg, antibiotics), as well as a change of setting from a psychiatric to a medical unit, the authors noted. They suggested further research into the role of fever in treatment of psychiatric illness, acknowledging that this cannot be done through the deliberate introduction of an infectious agent into a patient. Potential avenues for investigation include using sulforaphane or a similar noninfectious pyrogenic agent as adjunctive treatment for refractory psychosis, as well as examining whether there are specific febrile illnesses that are associated with improvement in psychosis.
An accompanying commentary by David A. Kahn, MD, noted that when pyrotherapy was used for treating psychosis, it was generally ineffective in cases not caused by syphilis.8 Additionally, the patient might have been suffering from an underlying central nervous system infection, such as Lyme disease, which might have improved as a result of the intravenous antibiotics.
Another explanation he suggested is that the antibiotics themselves, rather than the fever, were responsible for the improvement in the patient’s psychosis. He noted that certain antibiotics can cause adverse central nervous system reactions.9 If antibiotics may cause psychosis in a small subset of patients, it is conversely true that they may alter neurotransmitters and cause improvements in psychotic symptoms. “By time course, this cannot be excluded as a possible source of brain alteration in the current case,” he stated.
He added that it “behooves us to watch closely how medical comorbidities affect psychiatric illness.”
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