Tuberculosis - I. T. Pyatnochka 2005

Pulmonary tuberculosis combined with other conditions and pregnancy
Tuberculosis and mental disorders

Psychiatric patients belong to a high-risk group for tuberculosis. Active tuberculosis is detected in 3–6% of patients in psychiatric hospitals. Adult psychiatric inpatients contract tuberculosis 4–5 times more often than patients in somatic hospitals. The prevalence of mental disorders among newly diagnosed tuberculosis patients is 3–4%. Furthermore, tuberculosis-related mortality among psychiatric patients is several times higher than in the general population. Consequently, psychiatric hospitals present a high risk for the spread of tuberculosis infection.

The causes of high tuberculosis morbidity in psychiatric patients are multifaceted: violation of basic hygiene rules, decreased Immunity associated with malnutrition, refusal to eat, and non-adherence to hospital routines. In addition, it is hypothesized that mental illnesses weaken the regulatory role of the Central Nervous system in complex immune mechanisms. Notably, tuberculosis is more common in patients with Schizophrenia and less common in those with atherosclerotic dementia. Tuberculosis predominantly arises from endogenous reactivation and usually develops against the Background of a pre-existing mental illness; conversely, if psychiatric symptoms develop secondarily, the specific pathological process generally runs a more severe course.

In the majority of psychiatric patients, tuberculosis occurs and develops asymptomatically or with mild clinical manifestations. This is due to the patients' mental state, their inability to recognize the early clinical signs of the disease, and the inherent difficulties in their examination. All of this leads to tuberculosis being frequently diagnosed at an advanced stage, characterized by bacterial excretion (in 60–70%), cavity formation (in 80%), complications, and extrapulmonary lesions. Among the Clinical forms of Pulmonary Tuberculosis, infiltrative and Caseous Pneumonia predominate.

In active and mobile psychiatric patients, tuberculosis tends to be more torpid and milder. In contrast, apathetic, inactive, and inhibited patients predominantly suffer from severe, acute forms of tuberculosis.

The Treatment of tuberculosis comorbid with mental disorders is carried out in specialized wards of psychiatric hospitals. When selecting anti-tuberculosis drugs, it is essential to consider the potential psychotropic effects of certain chemotherapeutic agents. Notably, cycloserine, and less frequently isoniazid, can exert toxic effects on the central nervous system. Cycloserine-induced psychosis, as well as mental disturbances caused by isoniazid, require the immediate discontinuation of Chemotherapy and the Structure/175.html">Implementation of comprehensive management measures (detoxification, sedation, and vitamin therapy). Overall, the treatment of tuberculosis patients is conducted in accordance with universally accepted WHO recommendations.