A review of the interplay between tuberculosis and mental health

Aims

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.

Methods

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.

Results

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.

Conclusions

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.     

The token economy for schizophrenia: review of the literature and recommendations for future research

The token economy is a treatment intervention based on principles of operant conditioning and social learning. Developed in the 1950s and 1960s for long-stay hospital patients, the token economy has fallen out of favor since that time. The current review was undertaken as part of the 2003 update of the schizophrenia treatment recommendations of the Patient Outcomes Research Team (PORT). A total of 13 controlled studies of the token economy were reviewed. As a group, the studies provide evidence of the token economy's effectiveness in increasing the adaptive behaviors of patients with schizophrenia. Most of the studies are limited, however, by methodological shortcomings and by the historical context in which they were performed. More research is needed to determine the specific benefits of the token economy when administered in combination with contemporary psychosocial and psychopharmacological treatments.     

Child mental health in Latin America: present and future epidemiologic research

OBJECTIVE: This report reviews population studies of child and adolescent mental health carried out in Latin America over the past 15 years. Also considered is the issue of how to meet the needs of children and adolescents who may present mental health problems in Latin America, given that most of them live in poverty in economies that are underdeveloped, providing limited resources. METHOD: Ten studies from six different countries were identified that employed some form of randomized sampling method and used standardized instruments for assessment. The authors present a summary of the main characteristics of these studies, highlighting methodological features that may account for differences in the rates obtained. RESULTS: Overall, a similar pattern of prevalence and risk factors for mental health problems in children and adolescents in Latin American countries emerged. Moreover, rates of disorders in these children are similar to the 15 to 20% found in other countries. These findings are similar to those observed when adult mental health problems are considered. Prevention and treatment strategies are discussed and the peculiarities of the delivery of mental health services for children and adolescents are explored. CONCLUSIONS: Future research needs to focus on understanding of resilience and formal and informal mental health delivery systems of care available in different Latin American countries. Such research has high potential for ameliorating the prevention and treatment of child and adolescent mental health problems in this region of the world.     

COVID-19 pandemic and mental health consequences: Systematic review of the current evidence

BackgroundDuring the COVID-19 pandemic general medical complications have received the most attention, whereas only few studies address the potential direct effect on mental health of SARS-CoV-2 and the neurotropic potential. Furthermore, the indirect effects of the pandemic on general mental health are of increasing concern, particularly since the SARS-CoV-1 epidemic (2002–2003) was associated with psychiatric complications.MethodsWe systematically searched the database Pubmed including studies measuring psychiatric symptoms or morbidities associated with COVID-19 among infected patients and among none infected groups the latter divided in psychiatric patients, health care workers and non-health care workers.ResultsA total of 43 studies were included. Out of these, only two studies evaluated patients with confirmed COVID-19 infection, whereas 41 evaluated the indirect effect of the pandemic (2 on patients with preexisting psychiatric disorders, 20 on medical health care workers, and 19 on the general public). 18 of the studies were case-control studies/compared to norm, while 25 of the studies had no control groups. The two studies investigating COVID-19 patients found a high level of post-traumatic stress symptoms (PTSS) (96.2%) and significantly higher level of depressive symptoms (p = 0.016). Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. Studies investigating health care workers found increased depression/depressive symptoms, anxiety, psychological distress and poor sleep quality. Studies of the general public revealed lower psychological well-being and higher scores of anxiety and depression compared to before COVID-19, while no difference when comparing these symptoms in the initial phase of the outbreak to four weeks later. A variety of factors were associated with higher risk of psychiatric symptoms and/or low psychological well-being including female gender, poor-self-related health and relatives with COVID-19.ConclusionResearch evaluating the direct neuropsychiatric consequences and the indirect effects on mental health is highly needed to improve treatment, mental health care planning and for preventive measures during potential subsequent pandemics.     

Ambulatory mental health liaison research: a review and preview

Mental health liaison in primary care is a complex technology requiring scientific study and validation if we are to know when, where, and how to utilize it. Earlier studies have raised as many questions as they have resolved. Recommendations for future research are presented in relation to such issues as: How should mental health consultation/liaison be defined? How should consultation/liaison studies be prioritized? What aspects of consultation/liaison should be studied? What methodologies are appropriate?     

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review

ObjectiveThe lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France.MethodsThe authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France.ResultsWe identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of “COVID+ units”. These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic.DiscussionFrench mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.     

精神病与精神卫生学专业学位研究生教学案例库的建设

本文目的是探讨精神病与精神卫生学专业学位研究生(MDPM)教学案例库的建设。随着医学模式的转变和教育教学改革,探索新的研究生培养模式势在必行。MDPM教学案例库是理论联系实践的桥梁,可帮助学生巩固理论知识,提高研究生学习的自主性、主动性,锻炼临床思维,提高临床能力,从而提高研究生培养质量。     

Outcome measures used in forensic mental health research: a structured review

Background The evidence base for forensic mental health (FMH) services has been developing since the late 1990s. Are outcome measures sound enough for the evaluation tasks? Aims To identify, from published literature, outcome measures used in FMH research and, where feasible, assess their quality. Method A structured review was undertaken of trials and intervention studies published between 1990 and 2006. Details of outcome variables and measures were abstracted. Evidence regarding most frequently occurring outcome measures was assessed. Results Four hundred and fifty different instruments were used to assess outcomes, incorporating 1038 distinct variables. Very little evidence could be found to support the measurement properties of commonly used instruments. Conclusions and implications for practice There is little consistency in the use of outcome measure in FMH research. Effort is required to reach consensus on validated outcome measures in this field in order to better inform practice. Copyright © 2009 John Wiley & Sons, Ltd.     

Brain uptake and utilization of fatty acids: recommendations for future research

A primary goal of the international workshop "Brain Uptake and Utilization of Fatty Acids" was to identify research areas that would benefit from further investigation. The major themes for future research are presented below: (1) Elucidating the role of the developing and mature cerebrovascular endothelium (CVE) in the uptake of fatty acids (FA) into the brain. (2) Clarifying the role of diffusion and receptor-mediated uptake of FAs by various brain cell membranes and protein-mediated shuttling of FAs between the CVE and various brain cells and tissues. (3) Illuminating the mechanisms of intermediate metabolism and the roles of polyunsaturated fatty acids (PUFA) in astrocytes, neurons and oligodendrocytes. Of special interest are the long-chain omega-3 PUFA and their derivatives, such as lipoproteins, phospholipids and plasmalogens, that have been associated with various disease states (such as those listed in [5], below). (4) Elucidating the role of gene expression on long-chain omega-3 PUFA incorporation in membranes and the regulatory role these and other PUFA have on gene expression in the brain. (5) Elucidating the recently identified roles of long-chain omega-3 PUFA in mood disorders, schizophrenia, stroke, peroxisomal biogenesis disorders, Huntington's disease, other neurodegenerative disorders and disorders of oxidative stress. (6) Undertaking placebo-controlled clinical trials to assess the therapeutic potential of omega-3 PUFA in the above disorders. (7) Developing new, and utilizing existing animal models in the above studies. (8) Developing noninvasive imaging and tagging methods for quantifying the migration and distribution of PUFA and their derivatives in the brain. (9) Applying multi-disciplinary collaborations among biophysicists, physiologists and molecular biologists to the resolution of the above.     

The Bucharest Early Intervention Project: case study in the ethics of mental health research

The Bucharest Early Intervention Project is the first ever randomized controlled trial of foster care as an alternative to institutional care for young abandoned children. This article examines ethical issues in the conceptualization and implementation of the study, which involved American investigators conducting research in another country, as well as vulnerable participants. We organize the discussion of ethical questions about the study around several key issues. These include the nature and location of the vulnerable study population, the social value of conducting the study, the risks and benefits to participants of participating in the study, and posttrial obligations of the investigators. In discussing how these questions were addressed as the study was designed and after it was initiated, we describe our attempts to wed sound scientific practices with meaningful ethical protections for participants.     

The value of art therapy in antenatal and postnatal care: A brief literature review with recommendations for future research

There is a very small body of literature addressing the use of the arts or art therapy in antenatal and postnatal care, and much of it is qualitative, including some rich and complex data which are worthy of discussion and consideration. Overall, it points to a promising use of supportive and therapeutic arts in this area. This article presents some background on the use of the arts specifically focusing on postnatal depression and birth trauma. It then moves on to present a brief survey of literature in the field, followed by some further reflections and discussion about further research needed to establish clinical utility and economic viability.     

精神病与精神卫生学专业学位研究生教学案例库应用评价

目的 探讨初步建成的精神病与精神卫生学专业学位研究生教学案例库的应用价值。 方法 采用自编教学案例库问卷对已建成的精神病与精神卫生学专业学位研究生教学案例库进行评价,评估学生、教师和专家对教学案例库的满意度情况。 结果 学生、教师和专家对教学案例库总体评价满意率分别为86.0%、88.9%、83.3%,提高学习自主性的满意率分别为97.7%、97.2%、100.0%。学生评问卷中,巩固理论知识、提高学习兴趣、提高学习效率、提高病历书写能力、锻炼临床思维和提高临床能力的满意率分别为97.7%、95.3%、93.0%、90.7%、97.7%、90.7%;教师评问卷中,符合教学大纲、案例资源丰富、提高学习兴趣、有助于教学、提高临床思维的满意率分别为97.2%、83.3%、91.7%、100.0%、94.4%;专家评问卷中,符合教学大纲、选材恰当、编排合理、结构严谨、层次分明、分析准确、具有启发性、提高临床思维能力的满意率分别为91.7%、91.7%、83.3%、83.3%、91.7%、91.7%、83.3%、100.0%。 结论 已建成的精神病与精神卫生学专业学位研究生教学案例库总体评价较好,有助于提高学生的自主性和临床思维能力等。     

Secondary depression in alcoholism: Implications for future research

While an association between excessive consumption of alcohol and depression has long been suspected it has only recently been demonstrated. This is probably due to the fact that only during the last 15 years have research diagnostic criteria for both alcoholism and depression been developed. The relationship between alcoholism and depression appears to be unidirectional in that the presence of an affective disorder does not seem to predispose to alcoholism (except perhaps in women), whereas the presence of alcoholism does appear to lead to subsequent development of depressive symptomatology. Unfortunately, there is a very wide range in the reported frequency of depression among alcoholics. We will examine the literature on secondary depression in alcoholism in an attempt to clarify the parameters which may account for this.