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Mamatova Nargiza Toyirjonovna,
assistant of the department of phthisiology of the Samarkand State Medical Institute,
Samarkand, Uzbekistan
Khodjaeva Svetlana Ataхanovna,
Head of Department of phthisiology of the Samarkand State Medical Institute,
Samarkand, Uzbekistan
Ashurov Abduvali Abduhakimovich,
phthisiatrician of the highest category of the Samarkand regional Center for Phthisiology and Pulmonology,
Samarkand, Uzbekistan
Abduhakimov Bahrombek Abduvaliyevich,
medical prevention student Samarkand State Medical Institute,
Samarkand, Uzbekistan
THE EFFECT OF PULMONARY TUBERCULOSIS ON THE MENTAL STATE OF ADOLESCENTS
ABSTRACT
A comparative assessment of the psychological characteristics of adolescents with pulmonary tuberculosis. The
personal characteristics of 100 adolescents aged 13-17 treated at the Samarkand Regional Center for Tuberculosis and
Pulmonology, as well as various features of newly diagnosed respiratory tuberculosis, were studied, including 58 (58%)
girls and 42 (42%) boys.
Patients with MDR-TB see themselves as altruistic, more likely to feel willing to sacrifice
their own interests, help others, and show compassion. Such adolescents tend to make a pleasant impression on others
and idealize interpersonal relationships that typically show tenderness, sensitivity, and compassion for them (p <0.05).
In adolescents with pulmonary tuberculosis with widespread processes, personality traits that determine the formation
of neurosis were observed: insecurity, emotional instability, anxiety, weakness. In a small group with limited lesions,
high rates of resentment and hostility were rare.
Keywords:
pulmonary tuberculosis, adolescent, personal characteristics, patient
Маматова Наргиза Тойиржоновна,
ассистент кафедры фтизиатрии
Самаркандского Государственного медицинского института,
Узбекистан
Ходжаева Светлана Атахановна,
Заведующий отделением фтизиатрии
Самаркандского Государственного медицинского института
Ашуров Абдували Абдухакимович,
врач-фтизиатр высшей категории
Самаркандского областного центра фтизиатрии и пульмонологии
Абдухакимов Бахромбек Абдувалиевич,
студентка лечебной профилактики
Самаркандского Государственного медицинского института
ВЛИЯНИЕ ТУБЕРКУЛЕЗА ЛЕГКИХ НА ПСИХИЧЕСКОЕ СОСТОЯНИЕ ПОДРОСТКОВ
АННОТАЦИЯ
Проведена
с
равнительная оценка психологических характеристик подростков с туберкулезом легких.
Изучены личностные характеристики 100 подростков 13-17 лет, проходивших лечение в Самаркандском
областном центре туберкулеза и пульмонологии, а также различные особенности впервые выявленного
туберкулеза органов дыхания, в том числе 58 (58%) девочек и 42 (42%) мальчика. Результаты исследований и
их обсуждение. Пациенты с МЛУ-ТБ считают себя альтруистами, которые с большей вероятностью захотят
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пожертвовать своими интересами, помочь другим и проявить сострадание. Такие подростки, как правило,
производят приятное впечатление на других и идеализируют межличностные отношения, которые обычно
проявляют нежность, чувствительность и сострадание к ним (p <0,05).
Заключение. У подростков с туберкулезом легких с распространенными процессами наблюдались
личностные черты, определяющие формирование невроза: неуверенность, эмоциональная нестабильность,
тревожность, слабость. В небольшой группе с ограниченными поражениями высокий уровень негодования и
враждебности был редкостью.
Ключевые слова
: туберкулез легких, подросток, личностные характеристики, пациент.
Relevance.
In modern psychology, great
attention is paid to the study of the mental state of people
suffering from tuberculosis and other socially significant
diseases. In this case, the main research is devoted to the
study of the psychological appearance of adult patients
with tuberculosis (TB), but the various manifestations of
tuberculosis infection in children, especially adolescents,
have not been adequately studied, although knowledge of
these
features
may
help
adolescents
develop
psychological support in treatment and rehabilitation was
possible.
Reporting a diagnosis of tuberculosis is a
polymorphic condition that is a potent detrimental factor
leading to the development of individual reactions and
emotional disturbances in patients [1]. It has been
reported that more than 80% of newly diagnosed TB
patients experience severe neurotic changes that develop
against the background of existential depression,
decreased internal reserves, and impaired interpersonal
relationships [5].
One of the priorities in the fight against
tuberculosis as an infectious disease is to reduce the
source of tuberculosis infection and prevent the
development of new infections and diseases by fully
treating these newly diagnosed patients [7,10].
The wide-ranging problems associated with the
psychological aspects of childhood tuberculosis have not
been adequately studied. Interest in these issues is mainly
reflected in the study of changes in the psychological
state under the influence of developing infectious
diseases [4, 9]. In practice, the psychological state of
adolescents has a direct impact on the effectiveness of
treatment [2]. Only a few works have considered the
mental state of children and adolescents as one of the risk
factors for the development of the TB process [3,5],
provided a psychological basis for the need to develop a
comprehensive rehabilitation and prevention system in
TB outbreaks. The authors note that tuberculosis in one
of the parents leads to an increase in psychological stress
and a decrease in the child's resistance to stress, as well as
various psychological problems, which contribute to the
development of somatic and infectious diseases in
children from socially disadvantaged and disadvantaged
families [5]. One of the possible directions of studying
the psychological risk factors of the tuberculosis process
and developing a system of psychological rehabilitation
aimed at psychological prevention of the disease is to
assess the psychological characteristics of patients with
different features of respiratory tuberculosis [9,11,12].
The purpose of the work.
A comparative
assessment of the psychological characteristics of
adolescents with pulmonary tuberculosis.
Materials and inspection methods.
The
personal characteristics of 100 adolescents aged 13-17
treated at the Samarkand Regional Center for
Tuberculosis and Pulmonology, as well as various
features of newly diagnosed respiratory tuberculosis,
were studied, of which 58 (58%) were girls and 42 (42%)
were boys. Clinically, inflammatory tuberculosis - 56
(56%), focal tuberculosis - 17 (17%) and tuberculosis - 2
(2%) cases were observed. In the remaining 25% of
cases, tuberculosis of the intrathoracic lymph nodes,
disseminated
tuberculosis
and
fibrous-poplar
tuberculosis, caseous zotiljam were diagnosed. Bacterial
isolation was detected in 32 (32%) of adolescents, and
drug resistance of mycobacteria was detected in 22 (22%)
patients, of which 9 (41%) patients had multi-drug
resistance status. The extent of damage to lung tissue was
assessed in points, taking into account the specific
features of the disease: limited processes with
uncomplicated course - 1 point; uncomplicated processes
- 2 points: Complicated processes - 3 points: Complicated
processes - 4 points. Injury of 1-2 segments of lung tissue
was included in limited processes, in more than 2
segments of a single lung, or in the degree of bilateral
pathological changes in common processes [9]. The
grouping of patients according to the extent of lung tissue
injury and the course of the tuberculosis process is shown
in Table 1.
Table 1.
Grouping of adolescents according to the extent of lung tissue damage and the course of tuberculosis.
Ball
Process distribution
Number of patients (%)
1
Uncomplicated limited processes
50
2
Uncomplicated processes with uncomplicated course
36
3
Limited processes that complicate the course
-
4
Unrestricted processes that are complicated to pass
14
Quantitative
assessment
The
amount
of
destructive changes corresponded to the size of the
landslide: no destructive changes - 0 points: the size of
the landslide was up to 2 cm - 1 point: the size of the
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landslide was from 2 to 4 cm - 2 points: the size of the
landslide was from 4 to 6 cm - 3 points: the size of the
sliding cavity greater than 6 cm - 4 points. Table 2
presents the results of a systematic assessment of
destructive changes in the lungs.
Table 2
.
Grouping of adolescents according to the extent of destructive changes in lung tissue
Ball
The magnitude of the destruction changes
Number of
patients
(%)
0
Absence of destructive changes
52
1
The size of the decay cavity is up to 2 sm
31
2
The size of the decay cavity is 2 to 4 sm
12
The total amount of TB lesions of lung tissue
was generated as a general radiological index (RI),
defined as low, medium, and high, taking into account the
specific features of the disease, as well as the extent of
destructive changes. In the assessment of clinical
symptoms, the severity of the general disorder syndrome
was determined: markedly underdeveloped - 1 point:
moderately developed - 2 points: clearly developed - 3
points. The presence of asthenoneurotic reactions without
an increase in div temperature is a slight manifestation
of the general disorder syndrome: moderate - a
combination of asthenoneurotic reactions with functional
disorders of various organs and systems, as well as
minimal changes in peripheral blood; clearly developed -
a combination of asthenoneurotic reactions with
functional disorders of various organs and systems, as
well as moderate and marked changes in peripheral
blood, paracetamol reactions [9]. The distribution of
patients according to the manifestation of the symptom
complex of general disorders is given in Table 3.
Table 3.
The division of adolescents into groups according to the manifestation of symptoms of common disorders
Ball
The severity of the symptoms of general disorders
Number of patients
(%)
0
Unchanged
33
1
Not clearly developed
25
2
Moderately developed
26
3
Clearly developed
16
Based on a comprehensive evaluation of clinical
and laboratory data, the severity of the general disorder
syndrome reflected a general intoxication index (II):
defined as low, moderate, and high.
Adolescent psychological examination was
performed at the diagnostic stage, before chemotherapy.
A study of the main factors pertaining to the individual R.
Kettell’s personality questionnaire (a form adapted for
adolescents), personality aggression, forms of disruptive
behavior - A. Bass and A. Perceptions, leading
interpersonal style - T. Liri survey, alexithymia level -
was conducted using the Toronto alexithymic scale.
Psychological status assessment methods were also used:
SCL-90-R, a questionnaire on the development of
psychopathological symptoms, an eight-color test
produced by Lusher [11]. In statistical analysis, we used
parametric and non-parametric comparison methods
(Student's t-principle, Mann-Whit's U-principle), as well
as Fisher's accuracy and r-Pearson's correlation
coefficient. The differences were found to be significant
at
p
<0.05.
Research results and their discussion.
A
comparative analysis of the data obtained allowed to
identify significant differences in the emotional
characteristics and social behavioral regulation features
(factors C and G in R. Kettell’s survey) of patients with
different prevalence of the TB process. In adolescents
with common processes, personality traits that determine
the formation of neurosis were observed: insecurity,
emotional instability, anxiety, weakness (factor C). Factor
C, indicating “emotional instability,” was more common
in adolescents with widespread processes in the lungs
(21% of cases) and less common in limited processes
(7% of cases,
p
<0,05). However, in 37% of adolescents
with common processes, features characterized by “high
normative behavior” (G factor) were observed: desire to
follow generally accepted rules and norms, make a good
impression
on
others,
idealize
themselves
and
interpersonal relationships (in limited processes - 12% of
cases,
p
<0,05). In a small group where widespread
processes were present, personality-based destructive
attitudes such as resentment and hostility were more
pronounced (60% of cases). High rates of resentment and
hostility are rare in a small group with limited lesions
(39% of cases,
p
<0,05). It was found that authoritarian
behaviors predominate in the interpersonal relationships
of patients with common processes: the pursuit of
competent leadership, influence on others, self-direction
(39% of cases; among limited processes - 19% of cases:
p
<0,05). Adolescents with varying degrees of lung
collapse also found significant differences in emotional
personality traits. Low values for factor C (“emotional
instability” factor) are more common in patients with a
ruptured cavity than in patients without a ruptured cavity
(24 and 8%, respectively,
p
<0,05). In addition to the
above-mentioned neurotic changes, elevation of factor D
(“high emotional excitability”) was observed in 17 and
2% of cases (
p
<0,05) in patients with degenerative
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cavities. The high level of factor D is characterized by a
lack of emotional control, the manifestation of various
affective reactions in situations that are subjectively
difficult for a person (conflict between desire and
opportunity, lack of respect and recognition, etc.).
Compared with patients with high RI, patients with low
RI had “low emotional arousal” rates of factor D (52 and
35% of cases, respectively,
p
< 0,05). Adolescents with
low RI were also characterized by stress tolerance (49
and 29%, respectively,
p
< 0,05). Neurotic changes
associated with the presence of weakness, anxiety,
depression, fear, guilt, and low self-esteem were more
pronounced in patients with high and moderate
intoxication
indexes
compared
with
low-index
adolescents (O factor high: “anxiety” - 31 and 15% of
cases,
respectively,
p
<0,05).
In
interpersonal
relationships, 72% of patients with a high and moderate
intoxication index tend to exhibit verbal aggression,
while only 48% of patients with a low intoxication index
have such features (
p
<0,05).
In 60% of patients with bacterial excretion,
personality traits, i.e., emotional sensitivity, softness,
need, are more reflected (upper pole of factor I:
"sensitivity"). In non-bacterial adolescents, these features
were detected in only 29% of cases (
p
<0,05).
Considering drug resistance (MDR-TB), the personal
characteristics of adolescents, the peculiarity of
interpersonal relationships, criticism of others, social
phenomena, skepticism of other people's opinions are
strongly developed. A similar pattern occurs in 35% of
patients with MDR-TB and in only 8% of adolescents
who are sensitive to the main drug (
p
<0,05). At the same
time, patients with MDR-TB feel more altruistic, more
willing to sacrifice their own interests, help others, and
show compassion. Such adolescents tend to make a
pleasant impression on others and idealize interpersonal
relationships that typically show tenderness, sensitivity,
and compassion for them (
p
<0,05).
Conclusion.
In adolescents with pulmonary
tuberculosis with widespread processes, personality traits
that determine the formation of neurosis were observed:
insecurity, emotional instability, anxiety, weakness. In a
small group with limited lesions, high rates of resentment
and hostility were rare.
In 60% of patients with bacterial excretion,
personality traits, i.e., emotional sensitivity, softness,
need, were more reflected. In non-bacterial adolescents,
these features were detected in only 29% of cases (
p
<0,05).
MDR-TB strongly developed the personal
characteristics of adolescents, the peculiarity of
interpersonal relationships, criticism of others, social
phenomena, skepticism of other people's opinions.
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