A multimorbid patient: Relationship between tuberculosis, somatic diseases, and some mental disorders

Introduction. One of the reasons for the adverse results of anti-tuberculosis treatment is the impairment of the patient’s emotional state and the development of their psychological distress with the symptoms of anxiety and depression. Another problem is the combination of tuberculosis with other somatic diseases, which results in prescribing more medications and increasing the number of adverse chemotherapy responses, reduces their treatment adherence, and leads to developing drug-resistant tuberculosis strains. Identifying the correlation relationship between tuberculosis, somatic diseases, and mental disorders is an urgent task of contemporary medicine in terms of selecting the optimal treatment approaches to such multimorbid patients. The aim was to study the relationship between the clinical manifestations of anxiety and depression and comorbid status in patients with different clinical forms of tuberculosis. Materials and Methods. The study included 265 patients with various clinical forms of respiratory tuberculosis. The 72 ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2025 Том 18, вып. 1ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ lung tissue damage degree was assessed, as well as the total area of the lung tissue decay, massiveness of bacterial excretion, drug resistance range of the causative agent, and bronchial obstruction severity degree according to the forced expiration volume within the 1st second (FEV1). To identify the patients’ comorbidity levels, we used the Cumulative Illness Rating Scale. To assess the patients’ emotional states, we used the Hospital Anxiety and Depression Score. Results and Discussion. In the most severe group in terms of clinical manifestations of tuberculosis, such as weight loss, bacterial excretion, drug resistance of the pathogen, the proportion of strains with extensive drug resistance, a high drug resistance index, the predominance of destructive changes in the lungs and their significantly larger area, the degree of prevalence in the lungs, and the bronchial obstruction index, the study included patients with fibrous- cavernous tuberculosis compared with patients with disseminated, infiltrative forms and tuberculomas. Disseminated tuberculosis was the next most severe; and the least severe symptoms (according to these criteria) were in patients with tuberculomas. The most common comorbidities in tuberculosis patients under study were gastrointestinal diseases (37.35%) and cardiovascular diseases (24.9%). The highest comorbidity index was observed in patients with disseminated (5.75) and fibrous-cavernous tuberculosis (5.5), the lowest - with tuberculomas (4.56). Depressive symptoms in the study were significantly associated with a high frequency of perceived symptoms of physical illness and/or high comorbidity, clinical manifestations of tuberculosis. The depression indicator had positive correlations with the number of the patient’s complaints (R = 0.28), the comorbidity degree (R = 0.12), and the decay area in the lungs (R = 0.12). The most severe depression manifestations accompanied fibrous-cavernous tuberculosis. Patients with tuberculomas had the lowest level of depression. Conclusions. The data obtained can be used to select impact points when creating optimized treatment programs for multimorbid patients with tuberculosis.