Tuberculosis: comorbidity with psychiatric and psychological disorders

Review

Maintaining adherence to treatment today is one of the key points in overcoming the epidemic of drug-resistant tuberculosis. In this regard, it becomes relevant to study the quality of life, psychological and mental disorders in patients with tuberculosis in order to further correct them and increase patient’s adherence to treatment. The purpose of the study was to investigate prevalence of psychological and psychiatric disorders in tuberculosis patients. Materials and methods. Medical records of 340 patients of Kharkiv Regional Clinical Psychiatric Hospital No. 3 were included in retrospective study for 2015-2019. 100 patients of Kharkiv Regional Tuberculosis Dispensary No. 1 and 20 healthy persons were included in prospective study and were interviewed with fs-36 scale. Results. The prevalence of schizophrenia, schizotypal and schizoaffective disorders (80%), mental retardation (12%) and other mental disorders, in particular due to brain damage or somatic disease (8%) in patients with tuberculosis was found. Significant differences were found in the quality of life parameters in patients with tuberculosis and in healthy individuals, as well as a deterioration in the quality of life with an expansion of the drug-resistance spectrum.

Conclusions. As a result of the study, the main mental disorders observed in patients with tuberculosis were identified, and a significant deterioration in the quality of life parameters in patients with tuberculosis and their dependence on the spectrum of drug-resistance were found.

Key words: tuberculosis, psychiatric disorders, psychological disorders

Introduction. Tuberculosis (TB) remains a great burden for many countries and especially for people from vulnerable groups. About 10 million new TB cases of the disease and about 1,500,000 of TB deaths are registered annually [1]. The relationship between tuberculosis and mental disorders has long been known, but not well understood. Mental disorders, such as anxiety, affective disorders, drug addiction are often found among patients with tuberculosis [2-4] and can occur as a result of tuberculosis disease, and vice versa can be risk factors for its development due to the emergence of certain patterns of social behavior that lead to weakening of the immune system and increasing the chances of infection [5], as well as reduce adherence to treatment [6]. In some social groups, the double stigmatization of tuberculosis patients and patients with mental disorders creates significant barriers to preventive and therapeutic measures.

On the other hand, there are some studies that show an increase in the tuberculosis treatment effectiveness with the additional use of psychotherapeutic methods. In particular, such studies were provided in India [7], Peru [8], Ethiopia [9]. All of them showed a decrease in stigmatization of patients, an increase in adherence to treatment and an increase in the treatment effectiveness of both drug-sensitive and multidrug-resistant tuberculosis.

Therefore, the need for understanding the relationship between tuberculosis and mental disorders and the creation of holistic, interdisciplinary, personality-oriented health systems for the treatment of tuberculosis and concomitant mental disorders are obvious, especially in low- and middle-income countries.

The purpose of the study was to investigate prevalence of psychological and psychiatric disorders in tuberculosis patients.

Materials and methods. Medical records of 340 patients of Kharkiv Regional Clinical Psychiatric Hospital No. 3 were included in retrospective study for 2015-2019. 100 patients of Kharkiv Regional Tuberculosis Dispensary No. 1 and 20 healthy persons were included in prospective study and were interviewed with fs-36 scale. Statistical data processing was carried out with Statistica 8.0.

Results and discussion. A retrospective study of the structure of psychiatric pathology among 340 patients with tuberculosis who were hospitalized in the Kharkiv Regional Psychiatric Hospital No. 3 2015-2019 showed the predominance of schizophrenia, schizotypal and schizoaffective disorders (80%), mental retardation (12%) and other mental disorders, in particular due to brain damage or somatic disease (8%).

A prospective assessment of the quality of life of patients treated for tuberculosis in the Kharkiv Regional TB dispensary No. 1 and healthy individuals showed good results in the healthy control group (Group 0; n = 20), slightly lower in patients with drug-sensitive tuberculosis (Group 1; n = 50), and the lowest one - in patients with multidrugresistant tuberculosis (Group 2, n = 50) in parameters of: vital signs (Group 0 - 68.75 ± 0.95; Group 1 - 34.4 ± 3.3; Group 2 - 6.72 ± 1.6; p <0.05), social functioning (Group 0 - 100.00; Group 1 - 62.4 ± 4.1; Group 2 - 33.4 ± 3.5; p <0.05), the role function due to the emotional state (Group 0 - 100; Group 1 - 40.6 ± 5.8; Group 2 - 22.5 ± 4.4; p <0, 05) and general mental health (Group 0 - 68.0 ± 0.65; Group 1 - 52.5 ± 2.2; Group 2 - 29.3 ± 1.6; p <0.05). A comparison of the quality of life in groups is presented in Table 1.

Table 1 - Comparison of quality of life with sf-36 scale

Parameter

Group 0 – Healthy persons

Group 1 – Patients with drug-sensitive tuberculosis

Group 2 – Patients with multidrug-resistant tuberculosis

Vital signs*

68.75 ± 0.95

34.4 ± 3.3

6.72 ± 1.6

Social functioning*

100.0

62.4 ± 4.1

33.4 ± 3.5

Role function due to the emotional state*

100.0

40.6 ± 5.8

22.5 ± 4.4

General mental health*

68.0 ± 0.65

52.5 ± 2.2

29.3 ± 1.6

* significant difference between groups (p<0.05)

The results obtained indicate the need for screening for tuberculosis among patients with mental disorders, since the features of their behavior and lifestyle can be a risk factor for the development of tuberculosis.

The decline in the quality of life in patients with tuberculosis and their psychological disorders, especially increasing with the expansion of drug-resistance, require the introduction of psychological assistance in the treatment plan, which can help patients cope with stress and increase their adherence to treatment.

Conclusions. As a result of the study, the main mental disorders observed in patients with tuberculosis were identified, and a significant deterioration in the quality of life parameters in patients with tuberculosis and their dependence on the spectrum of drug-resistance were found. The data obtained indicate the feasibility of screening for tuberculosis among patients with mental disorders and the introduction of psychological assistance to patients with tuberculosis.

References

  1. World Health Organization. Global Tuberculosis Report 2019. Geneva: WHO; 2019.
  2. A review of the interplay between tuberculosis and mental health / Doherty AM [et al.] // Gen. Hosp. Psychiatry. – 2013. – Vol. 35, № 4. – P. 398–406. doi: 10.1016/j.genhosppsych.2013.03.018
  3. Depression among patients with tuberculosis: determinants, course and impact on pathways to care and treatment outcomes in a primary care setting in southern Ethiopia – a study protocol / Ambaw F [et al.] // BMJ Open. – 2015. – Vol. 5, №7. – P. e007653. doi: 10.1136/bmjopen-2015-007653
  4. Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of communitybased data from 48 low- and middle-income countries / Koyanagi A [et al.] // BMC Med. – 2017. – Vol. 15, № 1. – P. 209. doi: 10.1186/s12916-017-0975-5
  5. Tuberculosis and noncommunicable diseases: neglected links and missed opportunities / Creswell J [et al.] // Eur. Respir. J. – 2011. – Vol. 37, № 5. – P. 1269–82. doi: 10.1183/09031936.00084310
  6. Patient adherence to tuberculosis treatment: a systematic review of qualitative research / Munro SA [et al.] // PLoS Med. – 2007 – Vol. 4, № 7. – P. e238. doi: 10.1371/journal.pmed.0040238
  7. Psychotherapy improves compliance with tuberculosis treatment / Janmeja AK [et al.] // Respiration. – 2005. – Vol. 72, № 4. – P. 375–80. doi: 10.1159/000086251
  8. Psychosocial support groups for patients with multidrug-resistant tuberculosis: five years of experience / Acha J [et al.] // Global Public Health. – 2007. – Vol. 2, № 4. – P. 404–17. doi: 10.1080/17441690701191610
  9. Patients infected by tuberculosis and human immunodeficiency virus facing their disease, their reactions to disease diagnosis and its implication about their families and communities, in Burkina Faso: a mixed focus group and cross sectional study / Méda ZC [et al.] // BMC Res Notes. – 2016. – Vol. 9, № 373. doi: 10.1186/s13104-016-2183-3
Year: 2020
City: Shymkent
Category: Medicine