Das Mrinalini, Isaakidis Petros, Van den Bergh Rafael, Kumar Ajay M V, Nagaraja Sharath Burugina, Valikayath Asmaa, Jha Santosh, Jadhav Bindoo, Ladomirska Joanna
Médecins Sans Frontières (MSF) OCB, India;
Médecins Sans Frontières (MSF) OCB, India.
Glob Health Action. 2014 Sep 9;7:24912. doi: 10.3402/gha.v7.24912. eCollection 2014.
Management of multidrug-resistant TB (MDR-TB) patients co-infected with human immunodeficiency virus (HIV) is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive disorders. A mental health assessment before MDR-TB treatment initiation may assist in early diagnosis and better management of psychiatric illnesses in patients already having two stigmatising and debilitating diseases.
To address limited evidence on the baseline psychiatric conditions of HIV-infected MDR-TB patients, we aimed to document the levels of depressive symptoms at baseline, and any alteration following individualized clinical and psychological support during MDR-TB therapy, using the Patient Health Questionnaire-9 (PHQ-9) tool, among HIV-infected patients.
This was a retrospective review of the medical records of an adult (aged >15 years) HIV/MDR-TB cohort registered for care during the period of August 2012 through to March 2014.
A total of 45 HIV/MDR-TB patients underwent baseline assessment using the PHQ-9 tool, and seven (16%) were found to have depressive symptoms. Of these, four patients had moderate to severe depressive symptoms. Individualized psychological and clinical support was administered to these patients. Reassessments were carried out for all patients after 3 months of follow-up, except one, who died during the period. Among these 44 patients, three with baseline depressive symptoms still had depressive symptoms. However, improvements were observed in all but one after 3 months of follow-up.
Psychiatric illnesses, including depressive symptoms, during MDR-TB treatment demand attention. Routine administration of baseline mental health assessments by trained staff has the potential to assist in determining appropriate measures for the management of depressive symptoms during MDR-TB treatment, and help in improving overall treatment outcomes. We recommend regular monitoring of mental health status by trained counsellors or clinical staff, using simple, validated and cost-effective tools.
对合并感染人类免疫缺陷病毒（HIV）的耐多药结核病（MDR-TB）患者进行管理极具挑战性。这类患者需接受长期且可能有毒性的治疗，还可能患上多种不同的精神疾病，如焦虑症和抑郁症。在开始耐多药结核病治疗前进行心理健康评估，可能有助于对已患有两种污名化且使人衰弱疾病的患者的精神疾病进行早期诊断和更好的管理。
为解决关于HIV感染的耐多药结核病患者基线精神状况的证据有限的问题，我们旨在使用患者健康问卷9（PHQ-9）工具记录HIV感染患者基线时的抑郁症状水平，以及在耐多药结核病治疗期间接受个体化临床和心理支持后的任何变化。
这是一项对2012年8月至2014年3月期间登记接受治疗的成人（年龄>15岁）HIV/耐多药结核病队列的病历进行的回顾性研究。
共有45名HIV/耐多药结核病患者使用PHQ-9工具进行了基线评估，发现7名（16%）有抑郁症状。其中，4名患者有中度至重度抑郁症状。对这些患者给予了个体化的心理和临床支持。除1名在该期间死亡的患者外，所有患者在随访3个月后进行了重新评估。在这44名患者中，3名基线时有抑郁症状的患者仍有抑郁症状。然而，随访3个月后，除1名患者外，其他所有患者均有改善。
耐多药结核病治疗期间的精神疾病，包括抑郁症状，需要引起关注。由经过培训的工作人员进行常规基线心理健康评估，有可能有助于确定耐多药结核病治疗期间管理抑郁症状的适当措施，并有助于改善总体治疗结果。我们建议由经过培训的咨询师或临床工作人员使用简单、经过验证且具有成本效益的工具定期监测心理健康状况。
