This document discusses the psychiatric comorbidity and psychosocial impact of tuberculosis. It notes that people with mental illnesses are more likely to be exposed to TB, develop active TB, delay seeking care, miss doses, and default from treatment. This leads to greater risk of advanced disease, drug resistance, treatment failure, and death. The most common mental disorders seen in TB patients include mood disorders like depression, anxiety disorders, psychotic disorders, and substance use disorders. Treating mental illnesses can improve medication adherence, treatment completion rates, and reduce further drug resistance and mortality. The document also discusses specific psychiatric symptoms, common mental health issues associated with TB, and treatments for mental illness.

1. PSYCHIATRIC COMORBIDITY AND
PSYCHOSOCIAL IMPACT OF
TUBERCULOSIS
DR. JAG MOHAN PRAJAPATI (MD)
SENIOR RESIDENT
DEPARTMENT OF PSYCHIATRY
ABVGMC,VIDISHA

2. TUBERCULOSIS
N PSYCHIATRIC PATIENTS
GENERAL POPULATION
PSYCHIATRIC
MANIFESTATIONS
AFFECT
OUTCOME

3. PEOPLE WITH MENTAL ILLNESSES ARE
MORE LIKELY TO:
Be exposed to TB
Develop active TB
Delay seeking care
Miss doses
Default from treatment

4. AND THEREFORE, HAVE GREATER RISK
FOR:
Advanced disease
Drug resistance
Treatment failure
Community transmission
(prolonged infectiousness)
Death

5. • Medication adherence
• Treatment completion/Cure
rates
• While reducing:
• Emergence of further drug-
resistance
• Community transmission
• Reduce mortality
Treating
mental
illnesses can
improve:

6. THE MOST COMMON TYPES OF
MENTAL DISORDERS INCLUDE:
Mood disorders (e.g. depression,
bipolar disorder)
Anxiety disorders (e.g. generalized
anxiety, phobias)
Non-affective/psychotic disorders
(e.g. schizophrenia)
Acute stress reaction/PTSD
Substance-use disorders (e.g.
alcohol, opioids)

7. SYMPTOMS OF DEPRESSION
• 5 or more of the following 9 symptoms:
1. Depressed mood, often accompanied by severe anxiety
2. Markedly diminished interest or pleasure in activities
3. Appetite disturbance
4. Sleep disturbance
5. Physical agitation or psychomotor slowing
6. Fatigue, decreased energy
7. Feelings of worthlessness or inappropriate guilt
8. Decreased concentration or inability to make decisions
9. Recurrent thoughts of death or suicidal ideation.
Major Depressive Episode - Symptoms present most of the day,
nearly every day for at least 2 weeks

8. Anxiety
• Prevalence rate of 24% of TB patients.(Twice higher
than healthy controls)
• Symptoms of Anxiety:
a) Excessive worry
b) Difficulty controlling the worry
c) Restlessness or feeling keyed up
d) Fatigue
e) Difficulty concentrating or “mind going blank”
f) Irritability
g) Muscle tension
h) Sleep disturbance

9. COMMON ANXIETY DISORDERS
Generalized Anxiety Disorder
Panic Disorder
Obsessive/Compulsive Disorder
Agoraphobia

10. FEATURES OF A PANIC ATTACK
A sudden period of intense fear or discomfort.
Abrupt development of physical symptoms: heart
racing, sweating, shaking, shortness of breath, feeling
of choking, chest pain, nausea, dizziness.
Often accompanied by fear of dying or going crazy.

11. CO MORBID MENTALAND MEDICAL
ILLNESS
COMORBIDITY MENTAL DISORDER PREVALENCE Source
Tuberculosis Depression 11-80% Sweetland et al (2014) World
Psychiatry 13(3):325-326
Tuberculosis Depression/Anxiety 46-72% Pachi et al (2013) Tuberc
ResTreat 2013:1-37
Tuberculosis Any Mental
disorder
Up to 70% Doherty et al (2013) Gen
HospPsychiatr 35(4):398-406
TB/HIV co
infection
Depression 1.7x higher
risk
Deribew et al (2010) BMC
Infect Dis, 10:201

12. ASSOCIATED WITH POOR MEDICAL
OUTCOMES:
Medical Mental Outcome source
Tuberculosis Alcoholism Treatment delays Storla, DG, et al (2008) BMC
Public Health 8:15
Tuberculosis Mental disorder Drug resistance Johnson et al (2003) Indian J
Chest Dis Allied Sci. 45:105-9
MDR-TB Substance abuse Treatment default Franke et al 2008 Clin Infect
Dis 46(12):1844-51
Tuberculosis Alcoholism/ mental
disorder
Death (1.6x and
1.8x higher risk)
Duarte EC et al (2009) J
Epidemiol Community
Health. 63(3):233-8
MDR-TB Mental disorder Death Franke et al 2008 Clin Infect
Dis 46(12):1844-51

13. FIVE TYPES OF MENTAL HEALTH
PROBLEMS ASSOCIATED WITH
TUBERCULOSIS
Psychological reaction to the diagnosis or
treatment.
Psychiatric side effects from TB medications.
Physiological consequence of the
disease.(Inflammation)
Exacerbation or emergence of mental health
issues.(relapse, new onset)
Co morbidity as a result of shared risk factors
(substance abuse, low socioeconomic status)

14. PSYCHOLOGICAL REACTION TO THE
DIAGNOSIS OR TREATMENT
I. Social stigma.
 External: rejection, blame & discrimination
 Internal: shame, social withdrawal / isolation,
depression.
II. Social/occupational/functional impairment.
III. Vulnerable populations : Poverty, Seriously mentally
ill, Homeless, Incarcerated.
IV. Co-infection with HIV may significantly increase
the risk of depression by up to 70%

15. PSYCHIATRIC SIDE EFFECTS FROM
ANTI-TB MEDS
Psychiatric side-effects have been associated with the
following anti-TB medications:
Isoniazid: Psychosis , Liver toxicity.
Cycloserine:
• Systematic review and meta-analysis found 5.7% psychiatric side effects.
• MDR-TB study in Peru (n=75) found new onset of depression, anxiety, and
psychosis during treatment to be 13%, 12%, 12%, respectively.
• Previous reviews of case studies estimate frequency of 10-50%.

16. Rifampin
Ethambutol
Ethionamide
Streptomycin
Para amino salicylate Sodium
Ofloxacin
Levofloxacin
Moxifloxacin.

17. Psychosis: Isoniazid,
ciprofloxacin,
ethambutol and
rifampicin have all
been documented to
be associated with
psychosis; the
majority of the
literature referring to
this effect of Isoniazid.
Suicide: There have
been a number of
published case reports
examining larger
numbers of patients
with suicidal behavior
while receiving
Isoniazid treatment.

18. Cycloserine has reported
rates of psychiatric side-
effects of 20–33%.
Psychiatric side-effects
reported include mania,
insomnia and anxiety.
Rates of psychosis
secondary to Cycloserine
of up to 13% have been
described.
Isoniazid may interact
with antidepressant
medications, based on its
action as a weak MAOI.
Co- prescription of
selective serotonin
reuptake inhibitors
(SSRIs) or tricyclic anti-
depressants with MAOIs
is contraindicated,
potential to induce
serotonin syndrome.

19. TREATMENTS FOR MENTAL ILLNESS:
• Psycho pharmacological: Anti-psychotics,
Antidepressants, Mood-stabilizers, stimulants,
Anxiolytics.
• Psychotherapeutic:
 Talk therapy/Insight-oriented.
 Cognitive-Behavioral.
 Interpersonal therapy.
• Supportive (psychosocial):
 Problem-solving.
 Harm reduction (motivational interviewing).

20. THANK YOU