Abstract
Takeshi Terao, Jun Nakamura, Department of Psychiatry, University of Occupational and Environmental Health, Hisato Inatomi, Department of Urology, University of Occupational and Environmental Health, Akira Eto, Komine Eto Mental Hospital, Kitakyushu, Japan:
So far, little attention has been paid to the relationship between schizophrenia and bladder stones, although there are several reports such as urinary tract abnormalities due to chronic psychogenic polydipsia [1] and bladder dysfunction in schizophrenia [2], where neurobiological abnormalities of schizophrenia might have brought about bladder abnormalities. In the present report, conversely, the authors present a case of schizophrenia where the patient's mental state was affected by a bladder stone.
A 62-year-old male who was a long-term, psychiatric inpatient with refractory schizophrenia complained of dysuria. Urological examinations revealed that he had a large bladder stone. He was operated on for the stone, which was 68.7 g (57 × 47 × 27 mm). Surprisingly, after the operation, not only the patient's dysuria but also his mental state was much improved. His aggressiveness subsided, and his complaints to nurses dramatically decreased. Also, his delusions and thought incoherence improved. Moreover, before the operation he spent 5 months of the year in a closed ward for patients with severe symptoms, but after the operation he spent no time in it. Instead, he stayed in an open ward without any trouble for the subsequent year. During these 2 years, his psychotropics (mainly 30 mg a day of haloperidol) were kept almost unchanged.
It is unlikely that the relationship between the stone extraction and his mental improvement was coincidental. We believe that in schizophrenia bladder stones can be a burden on the mental state as well as on the bladder. Thus, psychiatrists should pay more attention to the physical condition of psychiatric patients.