Acute psychosis induced by inh, especially when given as part of the dots regimen, has a variable presentation, and should always be kept. Cycloserine induced psychosis among patients on second line. A large portion of the worlds population is infected with tb. With regard to management, it is known that acute psychosis induced by isoniazid and ethambutol tends to subside once the precipitating stresses are over or their intensity is reduced. Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol emb induced psychosis being rare. Isoniazid inh is an antibiotic used to treat infection with mycobacterium tuberculosis tb. Although the disease is inactive in the majority, up to 10 percent of these persons may become infectious in their lifetime. Isoniazid tablets isoniazid dose, indications, adverse. Individuals diagnosed with cannabisinduced psychosis had the highest risk of converting to a schizophrenia spectrum disorder during followup conversion probability 46%, 95% ci 35% to 57%. Treatment for isoniazidinduced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11. Substanceinduced psychosis is a form of psychosis brought on by alcohol or other drug use. The epilepsy foundation is the voice of people with epilepsy and their families.
The risk of substanceinduced psychosis converting to. Isoniazid is the most reliable and most commonly used medication for tuberculosis. An initial diagnosis of druginduced psychosis was made after a thorough screening for organincity and a psychiatric consultation, with isoniazid. Isoniazid induced psychosis self harm behaviour with. Request pdf on may 6, 20, anne m doherty and others published a. Drug induced psychosis volume 168 issue 2 rob poole, clare brabbins. All antituberculous therapy was discontinued and she was started on olanzapine 15mgday. When isoniazid is required in patients who are already receiving phenytoin, the phenytoin dose has to be adjusted because isoniazid decreases its clearance. The administration of pyridoxine, which has been advocated for the prevention and treatment of isoniazidinduced neurologic manifestations, failed to achieve desired results in isoniazidinduced psychosis.
Drugs that may lower seizure threshold epilepsy foundation. Isoniazid preventive therapy and pregnancy outcomes in hivinfected women in the tshepiso cohort. Isoniazid is recommended as preventive therapy for certain individuals. Many hypotheses are available to explain the mechanism of iip but lack conclusive evidence in its favour. The association of isoniazid and psychosis was first highlighted by. How to stabilize an acutely psychotic patient mdedge. If the address matches an existing account you will receive an email with instructions to reset your password. Hence, it has become the point of interest in our case. The concomitant occurrence of inh and emb induced psychosis and in a single individual is extremely uncommon. Isoniazid preventive therapy in hivinfected pregnant and postpartum women.
The lack of preexisting psychiatric illness and complete resolution of hallucinations and suicidal ideation upon discontinuation of the drug strongly supports the diagnosis of toxic psychosis due to isoniazid in this patient. In view of patients history and clinical findings, an initial diagnosis of pulmonary tuberculosis with. Isoniazid should be used with caution in patients with a history of psychosis. Increased age, injection substance abuse, and alcohol consumption have been associated with a higher risk of. Pdf isoniazid as part of directly observed treatmentshort course dots regimen is universally used. Psychosis is a known complication of isoniazid therapy, although infrequent. Blurred vision or loss of vision, with or without eye pain.
How to safely treat druginduced psychosis sunrise house. Thus, patients with isoniazid inducedpsychosis recover without specific treatment after the withdrawal of the offending drug. To report a suspected case of isoniazidinduced psychosis in a 31yearold woman. Isoniazidinduced psychosis in a patient on dots therapy. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset of symptoms remains highly variable. If the patient has an underlying primary psychotic disorder, such as schizophrenia or mania, illnessspecific intervention will help acutely and longterm. Hence, supplement of pyridoxine along with atypical antipsychotic drug might be recommended in tuberculosis patients with psychosis who needs inh therapy for treatment. The rate at which isoniazid is eliminated by the liver is racedependent. For latent tuberculosis it is often used by itself. Side effects of isoniazid isoniazid, warnings, uses. The most common symptoms include visual hallucinations, disorientation and memory problems. The majority of conversions to a schizophrenia spectrum diagnosis occurred during the first 3 years following the index treatment period, especially for cannabisinduced psychosis. Isoniazid is an antibacterial recommended for all forms of tuberculosis in which organisms are susceptible.
Peripheral neuropathy can occur in 1020% of patients on high doses, but this side effect is minimized by daily prophylactic administration of vitamin b6 pyridoxine. We describe adverse drug reactions and interactions with other drugs, food, and. Isoniazid inhibits the synthesis of mycoloic acids, an essential component of the bacterial cell wall. Isoniazid induced psychosis i ip is well reported with varied clinical presentations. Isoniazidinduced psychosis in a patient on dots therapy masood i. The epilepsy therapy project and epilepsy foundation decide to merge our personal stories and reflections. Major toxic reactions are peripheral neuropathies at conventional dosage and seizures from overdosage. Isoniazid as part of directly observed treatmentshort course dots regimen is universally used.
Use for children aged 211 years and patients with underlying conditions associated with tb should be considered on a casebycase basis. Over the next few days, a rapid and progressive improvement of the state of consciousness was observed. Substanceinduced psychoses converting into schizophrenia. Thank you for your interest in spreading the word about the bmj. Bedi, in 1994, reported a case of isoniazid psychosis in a 74yearold, who developed restlessness, irritability, aimless activity, and incongruous actions 10 days after starting isoniazid therapy. It can also occur when a person is withdrawing from alcohol or other drugs. Given the psychomotor agitation and insomnia presented by our patient, we choose to introduce olanzapine for its sedative properties, along with the discontinuation of isoniazid. Many patients who are identified as being at risk of. In 1996, tiwari reported a case of isoniazidinduced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Inclusion or absence of a drug label on the aidsinfo site does not imply endorsement or lack thereof by aidsinfo. A case of isoniazidinduced delirium the journal of. Isoniazid toxicity is associated with a high mortality rate. Isoniazidinduced acute psychosis in a patient with pleural. Inh induces generalized convulsions, coma and metabolic acidosis.
An appropriate workup may reveal the etiology of the psychosis. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Although a majority of druginduced psychosis cases stem from stimulant use or abuse, there are plenty of other drugs besides stimulants that can cause psychosis. This article will compare and contrast druginduced psychosis with symptoms of schizophrenia and explore why both are inextricably linked in some individuals. Thus, 60% of african americans and whites eliminate isoniazid slowly compared with only 10%20% of asians. Isoniazidinduced pellagra and the nacetyltransferase gene. Among isoniazid side effects, central nervous system alterations, such as psychosis, psychomotor agitation, and drowsiness are described, although rare.
Available formats pdf please select a format to send. It may also be used for atypical types of mycobacteria, such as m. Pyridoxine vitamin b6, 1050 mgday, decreases the risk of neural side effects. Advanced age, female gender, slow acetylators, malnutrition, hiv infection, preexisting liver disease, and extrapulmonary tuberculosis were identified as risk factors for isoniazidinduced hepatotoxicity. He was prescribed rifampicin, pyrazinamide, and ofloxacin and had no further psychotic symptoms. At therapeutic levels isoniazid is bactericidal against actively growing intracellular and extracellular mycobacterium tuberculosis organisms. Druginduced psychosis is characterized by hallucinations and delusions, which occur because of the effects the drugs have on the brain. The presumed mechanism of inhinduced seizure involves a decrease in the availability of gaba, which is the major inhibitory neurotransmitter in the central nervous. Acute psychosis induced by inh, especially when given as part of the dots regimen, has a variable presentation, and should always be kept in mind in the differential diagnosis. An initial diagnosis of druginduced psychosis was made, once we considered the possibility that her psychotic symptoms could have been secondary to isoniazid, and the patient was admitted to our inpatient unit. Isoniazid associated psychosis indian journal of pharmacy practice.
A druginduced psychosis is a psychotic state that can be triggered by drug use or withdrawal from drug or alcohol abuse. The role of pyridoxine supplementation in prevention or treatment of isoniazid associated psychiatric symptoms is unclear. Acute psychosis after recent isoniazid initiation ncbi. Isoniazid and ethambutolinduced psychosis prasad r, garg. Cyp2e1 genotype and isoniazidinduced hepatotoxicity in patients treated for latent. Isoniazid should be given with caution in patients with chronic hepatic disease e. Isoniazid therapy is often associated with minor, transient and asymptomatic elevations in serum aminotransferase levels but, more importantly, isoniazid is a well known cause of acute clinically apparent liver injury which can be severe and is sometimes fatal. Although, associated psychosis in certain cases is documented earlier. Substanceinduced psychotic disorders predict schizophrenia spectrum disorders to a greater extent than previously thought. Pdf acute psychosis after recent isoniazid initiation.
Active tuberculosis must be treated with multiple concomitant antituberculosis medications to prevent the emergence of drug resistance. Acute psychosis after recent isoniazid initiation europe pmc. Drug induced psychosis the british journal of psychiatry. Although safety is not established, isoniazid has been used with ethambutol to treat tuberculosis in pregnant women without harm to the fetus. For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. Isoniazid, also known as isonicotinic acid hydrazide inh, is an antibiotic used for the treatment of tuberculosis. Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent above hivaids. One female and two male patients aged 35 years, 55 years and 60 years respectively developed psychosis following isoniazid administration. Aidsinfo provides the following drug label solely as an example of the labels available for isoniazid.
All the three received 300 mg of isoniazid daily for the management of pulmonary tuberculosis. Resistance to isoniazid occurs because of mutations in the. Druginduced psychosis most often occurs with those that abuse stimulants, which is why theres a subclassification known as stimulant psychosis. Isoniazidinduced acute psychosis in a patient with. Several fdaapproved drug labels may be available for isoniazid. A 31yearold white woman without a prior psychiatric history presented with psychotic symptoms suspected to be related to prophylactic treatment with isoniazid after she tested positive to a tuberculin purified protein derivative test. Acute isoniazid inh overdose results in decreased pyridoxal5phosphate levels, decreased gammaaminobutyric acid gaba synthesis, increased cerebral excitability, and seizures. The diagnosis becomes especially challenging when the patient has tubercular meningitis or some other neurological disease. Isoniazidinduced psychosis with obsessivecompulsive. The current case establishes neuropathy with vitamin b6 deficiency as a possible cause for iip warranting early clinicians. Isoniazid induced hepatic toxicity is the most frequent major toxic effect. Patients with alcoholinduced psychosis were significantly older than patients with either cannabisinduced psychosis or amphetamineinduced psychosis. Isoniazid induced psychosis a rare case report on adverse drug reaction. A substance like lsd or pcp can induce psychotic symptoms for a short time, while drugs like marijuana or opioids may.
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