Psychiatric Morbidity and Other Factors Affecting Treatment Adherence in Pulmonary Tuberculosis Patients

Table 3

Prevalence studies of TB comorbidity in patients with chronic mental disorders.

First author/references	Study design	Results	Comments
Collins (1956) [102]	700 psychiatric inpatients in a mental hospital.	25 (14 with the diagnosis of schizophrenia) of them suffered from pulmonary tuberculosis and were under surveillance in the sanatorium.
Ohta, 1988; [103]	3,251 patients residing in Nagasaki city and diagnosed as schizophrenia between 1960 and 1978.	Eighty-two of the patients had tuberculosis.	The incidence rate of tuberculosis was significantly higher than that of the general population for both male and female schizophrenic patients.
Lopez (1994); [19]	43 psychiatric patients at a general hospital at time of discharge.	19% were PPD positive at time of discharge, with 2 patients requiring a course of isoniazid prophylaxis.
Saez (1996); [12]	85 men discharged to community living by the on-site mental health program between 1990 and 1992, in NY.	36.7% were PPD positive, 11.1% had inconclusive results, and 6.7% had active TB.	All HIV-positive men, PPD-positive or inconclusive and all had active TB.
McQuistion (1997); [20]	71 participants in a psychiatric day program of New York City teaching Hospital were given a skin tuberculin test.	17% had positive results.; Of the 20 patients with mood disorders, 6 patients (30%) had positive PPD results, accounting for half of all positive findings in the total group. Only 6 (14%) of 41 patients with psychotic disorders demonstrated positive PPD results.	11 of the 12 infected subjects had experienced at least one of seven risk factors of tuberculosis infection (immigration, intravenous drug use, alcohol abuse, history of homelessness, HIV seropositive, known exposure to a person with active TB disease, and currently living in a congregate care setting).
Sanchez (1998) [104]	Using a screening questionnaire to assess the likelihood of TB infection in a random sample of 187 patients seen by a psychiatric emergency service, based on exposure to risk factors (emigration, age over 32 years, male gender, prior psychiatric hospitalizations, injection drug use, alcohol abuse, known exposure to a person with active tubercular disease, and concurrent illness).	83% were older than 32 years, 61% were male, 48% were immigrants, 44% had prior psychiatric hospitalizations, 35% abused alcohol, 35% were homeless, and 17% admitted to intravenous drug use.	While these figures did not reach statistical significance, there appeared to be a trend between various risk factors and TB infection.
Sanchez-Mora (2007) [105]	154 psychiatric patients at a long-term mental institution.	4.5% prevalence rate of tuberculosis.
Pirl (2005); [106]	535 patients admitted to a state psychiatric Hospital, in Boston.	20.2% rates of positive; tuberculin compared with 5% screened positive in the US general population, 𝑧=16,12 𝑃<0.001.	Independent risk factors for markers of disease included age, immigrant status, homelessness, and history of substance use. The study confirms the alarmingly high occurrence of positive tuberculin skin tests.
Hashemi (2009); [107]	215 psychiatric patients in a long-term mental institution, in Hamedan, Iran.	28.8% rate of positive PPD results,; 40.3% of them had radiographic evidences of inactive pulmonary tuberculosis.	In Iran, higher prevalence rates were found in prisoners, drug abusers, and hospital employees; (50%, 66.7%, and 36.2%, resp.); however, they imply lower prevalence rates (1.6–14.2%) in low-risk groups.
Cavanaugh (2012); [108]	75 residents exposed to TB at the assisted living facility for adults with mental illness, in Florida.	88% were infected. By comparison, the prevalence of latent TB infection among reported contacts of pulmonary TB patients with positive sputum smears in the United States has been estimated at 20%–30%.	An elevated risk for TB infection among adults with mental illness and a risk for sustained transmission when they inhabit crowded congregate settings.