Clinical and psychopathological features of the schizophrenia, occurring on the background of the tuberculosis

The prevalence (relative frequency in the population) of the schizophrenia in the world is from 0.5 to 1.6%.
      According to various sources, the range of morbidity (frequency of incidence of new cases in the population) of the schizophrenia in the world varies from 0.3 to 22 cases per 1000 of population. The maximum value of the incidence of the schizophrenia in Europe - 7-26 cases per 1000 of population per year, at the age of 18-65 years, in Russian Federation - 0,22-1 case per 1000 population per year in the age group for 20-39 years.
        The schizophrenia refers to the top ten leading causes of disability in the world. So, in the report of the World Health Organization on the health status of the population in the world, the schizophrenia is among the eight diseases with the highest rate of disability per year in the age group for 15 to 44 years. More than 60% of schizophrenic patients of working age are recognized with disabilities, which is a consequence of the manifestations of the disease, but also, partly, of unwanted effects of therapy, reducing of the compliance to treatment and stigmatization of the disease.
          In general, the schizophrenia reduces the life expectancy of the patient, on average, for 10 years. Compared with a standardized age of the general population, the relative risk of mortality of men with schizophrenia increases in 4.7 times, that of women - in 2.3 times. Patients with schizophrenia are characterized by a significantly higher risk of death from systemic diseases (cardiovascular, endocrinologic, infectious diseases, tuberculosis, and others).
          The schizophrenia, especially proceeding with negative disorders, implies serious financial costs to patients, to their families and to the economy as a whole.
          The aim of our research [4] was the study of the pattern and of the severity of the asthenic syndrome with isolated schizophrenia and in combination with pulmonary tuberculosis.
            The asthenic syndrome is present in the structure of the schizophrenia as of the tuberculosis, which is of clinical interest, as an example of long-term interaction of exogenous (infectious) and endogenous processes. The duration and the severity of illnesses – the schizophrenia and the tuberculosis - determine the social value of their combination for years to come. The asthenia in schizophrenia is strongly expressed, usually dominated by mental exhaustion, which is disproportionate from mental tension; these disorders are combined with apathy and the decrease of the activity, as the disease progresses, it is less dependent on external conditions and on the activity of the patient, the irritability becomes increasingly inadequate, vegetative disorders are replaced by cenesthopathies. The asthenia rather often combines with obsessive, hypochondriac, affective and depersonalization disorders. The mental asthenia with tuberculosis is no different from asthenic conditions with other somatic diseases and is manifested by an increased mental exhaustion, apathy, oppression, etc. However, an emotional and hyperaestetic weakness is expressed more than with other diseases.
             To explore asthenic disorders in patients with schizophrenia complicated by tuberculosis were studied 30 patients undergoing a treatment in the State Health Institution “The First Republican psychiatric hospital of the Ministry of Health of the Udmurt Republic”. The control group included 30 patients with schizophrenia. The age of patients ranged from 17 to 68 years, the duration of the prevalence of schizophrenia was from 3 to 36 years, all were disabled by mental illness: group 2 disability was observed in 53 people, group 1 – in 7 patients. The duration of tuberculosis in the studied group ranged from 3 years to 2 months from the observation by phtisiologists in groups 1 and 2 of the Dispensary Registration Group. Among examined patients, 1 person had higher education, 17 – secondary special education, 27 - secondary education, the remaining 15 patients had incomplete secondary education.
             The main instrument of the survey was the scale of subjective evaluation of the asthenia MFI-20, allowing to assess the degree of severity of general asthenia, physical asthenia, reduced activity, reduced motivation, mental asthenia of patients in both groups (total points greater than 12 on at least one scale is the basis for the putting of the diagnosis of asthenia).
               The analysis of indicators of general asthenia scale revealed that the average indicator with a combination of schizophrenia and TB is 11.92, with an isolated schizophrenia – 13.37, that is 10.8% more than in the first group. By comparing with the physical asthenia scale, the average in the studied group amounted to 11.95, in the control group to 13.55, respectively, that is 11.8% more than in the first group. The rating averages of mental asthenia in the first group were 12.16, in the second group of studied people - 13.29, that is 8.8% higher than in the first group.
            If we consider the general asthenia, with schizophrenia combined with tuberculosis, it was found in 84.2 % of cases. With an isolated schizophrenia, the  percentage of occurrence was lower and amounted to 54.6 per cent. The physical asthenia in the studied group was observed in 82.3 % of cases, in the control group, in 55.3% of cases. The mental asthenia is also more frequent in schizophrenia with concomitant tuberculosis (86,8%), than in the schizophrenia without tuberculosis (55,2%).

The results of the ongoing research allow to formulate interim findings and to postulate hypothetical assumptions:

1. About the different psychodynamic structure of asthenic conditions in schizophrenic patients and in combination with pulmonary tuberculosis.
2. About the pathomorphosis of "classic" asthenic disorders in patients with schizophrenia complicated by pulmonary tuberculosis.
3. About the dominance of physical asthenia in the framework of a common pathogenetic process in patients with schizophrenia, combined with tuberculosis.