結核病與思覺失調症

The Relationship Between Tuberculosis and Schizophrenia

結核病是世界上最常見的傳染性疾病之一，每年都威脅著許多人的生命健康。思覺失調症屬於慢性精神疾病，平均盛行率約1%，是造成許多人失能的重要原因， 同時思覺失調症也常與其它身體疾病存在共病性的現象，思覺失調症患者的結核病盛行率明顯比一般人高，而在兒童時期的結核病感染也被認為可能是成年後思覺失調症發生的危險因子。有學者認為，兩者之間的相關性可能與許多因素有關，像是脂質代謝的異常或是兒童時期結核病引發的腦膜炎。此外，貧困、藥物濫用和愛滋病感染等問題也可能使思覺失調症患者發生結核病的機會增加。精神科病房和社區型療養機構屬於相對封閉的環境，可能會成為結核病散佈與疫情發生的溫床，因此精神療護與其他醫學領域的適當整合、常規的結核病篩檢與防治措施是為了避免群聚感染應當執行的方針。而治療思覺失調症患者的結核病也比一般病患困難，需投入更多耐心與心力，來面對藥物間的交互影響、副作用的發生與服藥順從性不佳等問題。

Tuberculosis is among the most common contagious diseases in the world and threatens many lives every year. Schizophrenia, a chronic mental illness with prevalence of about 1%, is a main cause of disability of people and is comorbid with many other physical disease. The prevalence of tuberculosis among schizophrenia patients is higher than in the average population. In addition, history of tuberculosis infection in childhood could be a risk factor for the development of schizophrenia in adulthood. Some proposed reasons for their relationship include lipid metabolism pathophysiology and tuberculosis induced meningitis in childhood. Among schizophrenia patients, poor nutrition, immune-dysfunction, poverty, substance abuse and HIV infection could be risk factors for tuberculosis. The relatively closed environment of psychiatric wards and community institutes may promote the transmission of tuberculosis among patients and induce the disease outbreak. Some practices should be promoted to avoid the outbreak, including well integration between psychiatric care and other physical medicine, routine TB screening and diagnosis. Finally, treatment of tuberculosis among schizophrenia patients is challenging, as it takes more patience and effort to deal with the drugs interaction, side effects and poor compliance.