ARTICLESAcute Neuropsychiatric Symptoms Associated With Antibiotic Treatment of Helicobacter Pylori Infections: A ReviewNEUFELD, NICHOLAS H. MD; MOHAMED, NOURHAN S. MD; GRUJICH, NIKOLA MD; SHULMAN, KENNETH MDAuthor Information NEUFELD, MOHAMED, GRUJICH, and SHULMAN: Department of Psychiatry, University of Toronto, Toronto, ON, Canada GRUJICH and SHULMAN: Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada N.S.M.: refined the search and analysis. N.H.N.: drafted the manuscript. All authors were involved in the search and analysis of the literature, revised the manuscript, and approved the final version submitted for publication. The authors declare no conflicts of interest. Please send correspondence to: Nicholas Neufeld, MD, Department of Psychiatry, University of Toronto, 841-250 College Street, Toronto, ON M5T 1R8, Canada (e-mail: [email protected]). Journal of Psychiatric Practice: January 2017 - Volume 23 - Issue 1 - p 25-35 doi: 10.1097/PRA.0000000000000205 Buy SDC Metrics Abstract Helicobacter pylori infects half the global population. Because serious complications can result from this infection, a so-called “triple therapy” is recommended: treatment with a proton-pump inhibitor and clarithromycin, along with amoxicillin or metronidazole. Although these antibiotics have been associated with neuropsychiatric symptoms, it is difficult to disentangle the effects of antibiotics from the effects of acute infections that may precipitate acute neuropsychiatric symptoms. Study of patients with chronic H. pylori infections who undergo antibiotic treatment may provide a clearer view of the associations between acute neuropsychiatric symptoms and antibiotics. The literature concerning this association in patients with H. pylori has not been reviewed. We therefore undertook a review of MEDLINE and postmarket surveillance data concerning this issue and identified 25 cases. Postmarket data indicated that gastrointestinal symptoms were the most commonly reported adverse reactions, followed by neurological adverse reactions; neuropsychiatric symptoms were less commonly reported, with variable and nonspecific terminology used to describe them. More specific, yet still variable terminology was found in the literature. Anxiety, delirium, dissociation, mania, and psychosis were reported, with approximately half of these neuropsychiatric symptoms occurring without symptoms of delirium. The use of standardized neuropsychiatric symptom rating scales and the Confusion Assessment Method for monitoring adverse reactions may improve our knowledge of neuropsychiatric symptoms and their association with antibiotics and thus mitigate underreporting. Physicians should remain alert to the possibility that neuropsychiatric symptoms may occur during antibiotic treatment of H. pylori and recognize that rapid resolution typically occurs with discontinuation of the antibiotics. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.