Kings College Hospital, Denmark Hill, London SE5 9RS.
Gen Hosp Psychiatry. 2013 Jul-Aug;35(4):398-406. doi: 10.1016/j.genhosppsych.2013.03.018. Epub 2013 May 6.
Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/substance abuse and migrant status leading to frequent comorbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.
A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. In total 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.
Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses, such as depression, may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects and some medications such as rifampicin may reduce the effective doses of anti-psychotics y their enzyme induction actions. Treatment with agents such as cycloserine has been associated with depression, and there have been reported cases of psychosis with most anti-tuberculous agents. Mental illness and substance abuse may also affect compliance with treatment, with attendant public health concerns.
As a result of the common co-morbidity of mental illness and tuberculosis, it is probable that physicians will encounter previously undiagnosed mental illness among patients with tuberculosis. Similarly, psychiatrists are likely to meet tuberculosis among their patients. It is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.
结核病和精神疾病有共同的危险因素，包括无家可归、HIV 阳性血清学、酒精/物质滥用和移民身份，导致两者经常并发。我们旨在生成一份全面的文献综述，研究结核病和精神疾病之间的复杂关系。
在 MedLine、Ovid 和 Psychinfo 中进行文献检索，并进一步检查这些文章的参考文献。共确定了 316 篇文章。由于缺乏随机对照数据，因此无法进行正式的荟萃分析。
在结核病患者中，精神疾病的发病率高达 70%。用于治疗常见精神疾病（如抑郁症）的药物可能与抗结核药物（尤其是异烟肼和越来越多的利奈唑胺）有显著相互作用。许多用于治疗结核病的药物可能会产生严重的精神不良反应，有些药物（如利福平）可能会通过其酶诱导作用降低抗精神病药物的有效剂量。使用环丝氨酸等药物治疗与抑郁有关，而且大多数抗结核药物都有报道出现精神病病例。精神疾病和物质滥用也可能影响治疗的依从性，引起公共卫生方面的关注。
由于精神疾病和结核病的共同高发病率，医生很可能会在结核病患者中发现以前未诊断出的精神疾病。同样，精神科医生也可能会在他们的患者中遇到结核病。重要的是，精神科医生和医生都应该意识到治疗结核病和精神疾病的药物之间可能存在相互作用。
