Objective To find out the situation of first diagnosed psychiatric disorders complicated with pulmonary tuberculosis patients in Hainan province, and we provide basis the effective rehabilitation treatment and prevent transmission of pulmonary tuberculosis for psychiatric disorders patients in Hainan.
Methods In this research, the diagnosis of psychiatric disorders was implemented, according to The 3rd edition of Chinese Classification and Diagnostic Criteria for Mental Disorders (classification of mental disorders). And pulmonary tuberculosis was diagnosed by the standards including Outpatient Diagnosis and Treatment Standard of Pulmonary Tuberculosis (2012 Edition), Health Industry Standard of the People’s Republic of China Diagnostic Criteria for Tuberculosis (WS288-2017), Guidelines for the Implementation of China’s Tuberculosis Control Program (2020 Edition), Clinical Guidelines for Diagnosis and Treatment of Tuberculosis. We used descriptive epidemiological analysis method to collect data of the psychiatric disorders and pulmonary tuberculosis patients with first diagnosed in Hainan Anning Hospital January 1, 2015–December 31, 2019, with patient’s base data, epidemiological characteristics and supervised therapy out of hospital.
Results This research collected 15 426 patients of psychiatric disorders with first diagnosed in Hainan Province Anning Hospital from January 1, 2015 to December 31, 2019 in all. And 31 patients of psychiatric disorders complicated with tuberculosis of 59 suspected tuberculosis patients were screened, the incidence rate of mental disease complicated with tuberculosis was 0.20%. In 31 pulmonary tuberculosis patients, 18 patients were male, 13 patients were female, average age was (41.8±11.2) years old; average of educated years was (6.5±5.2) years, average family population was (4.5±1.6); average illness duration of mental disease was (5.5±2.3) years, 9 cases were unmarried (29.0%), marriage in present had 11 cases (35.5%), 7 cases were divorce (22.6%), 4 cases were widowed (12.9%); 8 cases were farmers (25.8%), 23 cases were unemployed (74.2%). 31 patients, psychiatric disorders complicated with pulmonary tuberculosis, were all given consent to supervised therapy out of hospital, on the base of closely monitoring the comprehensive treatment of tuberculosis and psychotropic drugs. There were not missing cases under the observation during 1 year. After the one year treatment, patient’s total score of BPRS scale was (29.08±1.98). It was lower than that before treatment (36.30±1.96) significantly, the psychotic treatment effect was obvious ( P<0.05). There were 7 cases cured among 14 cases of smear-positive, which was 50.0% on cure rate. And 11 cases, finished the treatment completely, among 17 cases of smear-negative, which was 64.7% on standard treatment completion rate.
Conclusion Hainan province get a high incidence on psychiatric disorders complicated with pulmonary tuberculosis patients with first diagnosed, and low cure rate about tuberculosis. The tuberculosis screening and diagnosis ability of specialized medical unit for mental illness should be trained more and better, for preventing the misdiagnosis or missed diagnosis of tuberculosis, avoiding the spread of tuberculosis in mental hospitals, protecting the treatment safety of psychiatric patients in hospital.
摘要：目的 了解海南省精神疾病合并结核病情况, 为海南省精神疾病合并结核病的预防和控制提供依据。 方法 精神疾病诊断和治疗按中国精神障碍分类与诊断标准第三版(精神障碍分类)执行, 结核病诊断按《肺结核门诊 诊疗规范(2012年版)》、《中华人民共和国卫生行业标准肺结核诊断标准(WS288-2017)》、《中国结核病防治规划实施 工作指南(2020年版》和《临床诊疗指南, 结核病分册》执行, 以描述性流行病学分析方法收集海南省安宁医院2015年1 月1日一2019年12月31日就诊精神疾病合并结核病患者的基本资料、流行病学特征以及院外监督治疗情况进行统计 学分析。 结果 海南省安宁医院2015年1月1日一2019年12月31日共收就诊精神疾病患者15 426例, 初筛疑似结核 病患者59例, 最终确诊合并结核病31例, 合并结核病发生率为0.20%。31例精神疾病合并结核病患者中, 男性18例, 女性13例, 年龄(43.8±11.2)岁。受教育时间为(6.5±5.2)年, 家庭平均人口(4.5±1.6)人, 精神疾病患病平均时间(5.5±2.3)年；未婚9例(29.0%), 现婚11例(35.5%),离婚7例(22.6%), 丧偶4例(12.9%);农民8例(25.8%), 无业23例 (74.2%)。31例精神疾病合并结核病均按结核病督导和精神药物综合方案, 经1年治疗干预, 患者精神病评定量表 (brief psychiatric rating scale, BPRS)总分为(29.08±1.98), 比治疗干预前(36.30±1.96)明显降低, 精神病治疗效果明显( P <0.05)。14例涂阳结核病患者治愈7例, 治愈率为50.0%, 17例涂阴结核病患者完成治疗11例, 规范治疗完成率为 64.7%。 结论 海南省精神疾病合并结核病患者发生率较高, 且结核病治愈率低, 应加强精神疾病专科医疗单位结核 病筛査诊断能力培训, 防止结核病误诊和漏诊, 避免结核病在精神疾病院内传播, 保护院内精神疾病患者治疗安全。