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. Over the next few days, a rapid and progressive improvement of the state of consciousness was observed. Isoniazid associated psychosis indian journal of pharmacy practice. Request pdf on may 6, 20, anne m doherty and others published a. 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%. For latent tuberculosis it is often used by itself. Isoniazid is an antibacterial recommended for all forms of tuberculosis in which organisms are susceptible. The presumed mechanism of inhinduced seizure involves a decrease in the availability of gaba, which is the major inhibitory neurotransmitter in the central nervous. Although the disease is inactive in the majority, up to 10 percent of these persons may become infectious in their lifetime. Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol emb induced psychosis being rare. For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. In 1996, tiwari reported a case of isoniazidinduced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case.
Druginduced psychosis most often occurs with those that abuse stimulants, which is why theres a subclassification known as stimulant psychosis. Substanceinduced psychoses converting into schizophrenia. Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent above hivaids. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset of symptoms remains highly variable. The concomitant occurrence of inh and emb induced psychosis and in a single individual is extremely uncommon. The majority of conversions to a schizophrenia spectrum diagnosis occurred during the first 3 years following the index treatment period, especially for cannabisinduced psychosis. Substanceinduced psychotic disorders predict schizophrenia spectrum disorders to a greater extent than previously thought. Although, associated psychosis in certain cases is documented earlier. A large portion of the worlds population is infected with tb. Pdf isoniazid as part of directly observed treatmentshort course dots regimen is universally used. Isoniazidinduced acute psychosis in a patient with. 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. The most common symptoms include visual hallucinations, disorientation and memory problems. Major toxic reactions are peripheral neuropathies at conventional dosage and seizures from overdosage.
Acute isoniazid inh overdose results in decreased pyridoxal5phosphate levels, decreased gammaaminobutyric acid gaba synthesis, increased cerebral excitability, and seizures. It may also be used for atypical types of mycobacteria, such as m. Drugs that may lower seizure threshold epilepsy foundation. Isoniazidinduced psychosis in a patient on dots therapy masood i. 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. Isoniazidinduced acute psychosis in a patient with pleural. Patients with alcoholinduced psychosis were significantly older than patients with either cannabisinduced psychosis or amphetamineinduced psychosis. 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. An initial diagnosis of druginduced psychosis was made after a thorough screening for organincity and a psychiatric consultation, with isoniazid. The association of isoniazid and psychosis was first highlighted by. Thank you for your interest in spreading the word about the bmj.
Use for children aged 211 years and patients with underlying conditions associated with tb should be considered on a casebycase basis. Pyridoxine vitamin b6, 1050 mgday, decreases the risk of neural side effects. 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. The epilepsy foundation is the voice of people with epilepsy and their families. He was prescribed rifampicin, pyrazinamide, and ofloxacin and had no further psychotic symptoms. Isoniazidinduced psychosis with obsessivecompulsive. Advanced age, female gender, slow acetylators, malnutrition, hiv infection, preexisting liver disease, and extrapulmonary tuberculosis were identified as risk factors for isoniazidinduced hepatotoxicity. Imran masood 1, sanjay bhat 1, aadil beigh 1, veena gupta 2 1 department of medicine, ascoms and hospitals, jammu, j and k, india 2 department of chest medicine and tuberculosis, ascoms and hospitals, jammu, j and k, india click here for correspondence address and email. Thus, patients with isoniazid inducedpsychosis recover without specific treatment after the withdrawal of the offending drug. 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.
Isoniazid induced psychosis a rare case report on adverse drug reaction. Acute psychosis after recent isoniazid initiation ncbi. An appropriate workup may reveal the etiology of the psychosis. Cyp2e1 genotype and isoniazidinduced hepatotoxicity in patients treated for latent. Aidsinfo provides the following drug label solely as an example of the labels available for isoniazid. This article will compare and contrast druginduced psychosis with symptoms of schizophrenia and explore why both are inextricably linked in some individuals. Many hypotheses are available to explain the mechanism of iip but lack conclusive evidence in its favour. Many patients who are identified as being at risk of. We describe adverse drug reactions and interactions with other drugs, food, and. Thus, 60% of african americans and whites eliminate isoniazid slowly compared with only 10%20% of asians.
Active tuberculosis must be treated with multiple concomitant antituberculosis medications to prevent the emergence of drug resistance. Resistance to isoniazid occurs because of mutations in the. A druginduced psychosis is a psychotic state that can be triggered by drug use or withdrawal from drug or alcohol abuse. Several fdaapproved drug labels may be available for isoniazid. Although safety is not established, isoniazid has been used with ethambutol to treat tuberculosis in pregnant women without harm to the fetus. Isoniazid induced psychosis self harm behaviour with. Cycloserine induced psychosis among patients on second line.
Drug induced psychosis volume 168 issue 2 rob poole, clare brabbins. Acute psychosis induced by inh, especially when given as part of the dots regimen, has a variable presentation, and should always be kept. Isoniazid inh is an antibiotic used to treat infection with mycobacterium tuberculosis tb. Isoniazid and ethambutolinduced psychosis prasad r, garg. The role of pyridoxine supplementation in prevention or treatment of isoniazid associated psychiatric symptoms is unclear. Isoniazid induced psychosis i ip is well reported with varied clinical presentations.
Treatment for isoniazidinduced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11. 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. How to stabilize an acutely psychotic patient mdedge. Isoniazidinduced psychosis in a patient on dots therapy. Increased age, injection substance abuse, and alcohol consumption have been associated with a higher risk of. Isoniazid preventive therapy and pregnancy outcomes in hivinfected women in the tshepiso cohort. If the address matches an existing account you will receive an email with instructions to reset your password. One female and two male patients aged 35 years, 55 years and 60 years respectively developed psychosis following isoniazid administration. Inh induces generalized convulsions, coma and metabolic acidosis. Isoniazid toxicity is associated with a high mortality rate. Isoniazid is recommended as preventive therapy for certain individuals. Substanceinduced psychosis is a form of psychosis brought on by alcohol or other drug use.
If the patient has an underlying primary psychotic disorder, such as schizophrenia or mania, illnessspecific intervention will help acutely and longterm. Available formats pdf please select a format to send. Isoniazid preventive therapy in hivinfected pregnant and postpartum women. 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. All antituberculous therapy was discontinued and she was started on olanzapine 15mgday. Hence, supplement of pyridoxine along with atypical antipsychotic drug might be recommended in tuberculosis patients with psychosis who needs inh therapy for treatment. To report a suspected case of isoniazidinduced psychosis in a 31yearold woman. Isoniazid as part of directly observed treatmentshort course dots regimen is universally used.
Side effects of isoniazid isoniazid, warnings, uses. All the three received 300 mg of isoniazid daily for the management of pulmonary tuberculosis. It can also occur when a person is withdrawing from alcohol or other drugs. Isoniazid is the most reliable and most commonly used medication for tuberculosis. In view of patients history and clinical findings, an initial diagnosis of pulmonary tuberculosis with. 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. 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. The diagnosis becomes especially challenging when the patient has tubercular meningitis or some other neurological disease. Drug induced psychosis the british journal of psychiatry. Blurred vision or loss of vision, with or without eye pain. Among isoniazid side effects, central nervous system alterations, such as psychosis, psychomotor agitation, and drowsiness are described, although rare. Isoniazid inhibits the synthesis of mycoloic acids, an essential component of the bacterial cell wall. A substance like lsd or pcp can induce psychotic symptoms for a short time, while drugs like marijuana or opioids may. The epilepsy therapy project and epilepsy foundation decide to merge our personal stories and reflections.
At therapeutic levels isoniazid is bactericidal against actively growing intracellular and extracellular mycobacterium tuberculosis organisms. Inclusion or absence of a drug label on the aidsinfo site does not imply endorsement or lack thereof by aidsinfo. 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 should be used with caution in patients with a history of psychosis. A case of isoniazidinduced delirium the journal of. Druginduced psychosis is characterized by hallucinations and delusions, which occur because of the effects the drugs have on the brain. Acute psychosis after recent isoniazid initiation europe pmc. Isoniazid, also known as isonicotinic acid hydrazide inh, is an antibiotic used for the treatment of tuberculosis. Psychosis is a known complication of isoniazid therapy, although infrequent.
Isoniazidinduced pellagra and the nacetyltransferase gene. Pdf acute psychosis after recent isoniazid initiation. 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. Isoniazid induced hepatic toxicity is the most frequent major toxic effect. Hence, it has become the point of interest in our case. How to safely treat druginduced psychosis sunrise house. The rate at which isoniazid is eliminated by the liver is racedependent.
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