Cases of isoniazid induced psychiatric conditions reported in the literature include psychosis, obsessivecompulsive disorders, and mood alterations. A case of mania is rarely reported in this context. Case report earlyonset severe isoniazidinduced motor. Isoniazid is the most reliable and most commonly used medication for tuberculosis. Isoniazidinduced psychosis in a patient on dots therapy. Acute psychosis after recent isoniazid initiation europe. They noted increased psychomotor activity about one month prior to the. For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. The patient was discharged from the hospital with a diagnosis of inh induced seizures and psychosis classified as either toxic, brief reactive, or not otherwise specified. Isoniazidinduced psychosis with obsessivecompulsive. Take isoniazid at around the same time every scheduled day.
Daviss drug guide for rehabilitation professionals ciccone cd. Isoniazidinduced acute psychosis in a patient with. 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. Psychosis can happen to anyone, but it is most likely to happen. Disinhibition of central nervous system results from. At 1 week following the overdose, the patients mother reported. Isoniazid is highly effective but has many adverse effects, including neuropsychiatric. Isoniazid and ethambutolinduced psychosis europe pmc. Pdf on sep 29, 2014, muharrem burak baytunca and others published isoniazid induced psychosis with obsessivecompulsive symptoms schizo obsessive disorder in a female child find, read and. Isoniazid preventative therapy is widely used for latent tuberculosis infection. In 1996, tiwari reported a case of isoniazidinduced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case.
Isoniazid inh has been associated with neuropsychiatric side effects commonly peripheral neuropathy and psychosis. The mechanism of isoniazid induced psychosis is not well understood, but isoniazid is known to interfere with several metabolic pathways essential for normal neuronal functioning. Isoniazidinduced acute psychosis in a patient with pleural. Find patient medical information for isoniazid oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Isoniazid as part of directly observed treatmentshort course dots regimen is universally used. The role of pyridoxine supplementation in prevention or treatment of isoniazid associated psychiatric symptoms is unclear. Isoniazid associated psychosis indian journal of pharmacy practice. The risk of fatal isoniazid associated hepatitis appears to be increased among females, particularly female black patients and female hispanic patients. Isoniazid, also known as isonicotinylhydrazide inh, is an antibiotic used for the treatment of tuberculosis. Several neuropsychiatric adverse effects, following both therapeutic and overdose use of isoniazid, have been described and isoniazid induced psychosis, although uncommon, has been reported in the. The patient remained symptom free 11 months after discharge from the hospital. Isoniazid preventive therapy in hivinfected pregnant and postpartum women.
Isoniazid and ethambutolinduced psychosis prasad r, garg. Pdf most cases of antituberculous agentassociated psychoses. Isoniazidinduced lupus erythematosus presenting with. The concomitant occurrence of inh and emb induced psychosis and in a single individual is extremely uncommon. A case of isoniazidinduced psychosis in a 42yearold man. Rates of isoniazid induced hepatitis are 4fold higher in persons who drink alcohol daily compared to those who do not drink alcohol. Isoniazid induced psychosis i ip is well reported with varied clinical presentations. Case report isoniazid induced hepatitis and psychosis in a single patient case report ravouf parvaiz asimi et al.
Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain. Jan 01, 2007 read isoniazid associated psychosis, general hospital psychiatry on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Many hypotheses are available to explain the mechanism of iip but lack conclusive evidence in its favour. Gi disturbance was most pronounced after treatment with ethambutol and pas. Isoniazid induced psychosis a rare case report on adverse drug reaction. The advent of a new drug which is capable of causing convulsions, psychoses, and peripheral neuropathy as sidereactions is of interest to psychiatrists. 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.
Discuss common manifestations of psychotic disorders, including schizophrenia. One female and two male patients aged 35 years, 55 years and 60 years respectively developed psychosis following isoniazid administration. Compare characteristics of atypical antipsychotic drugs. Pdf isoniazid and ethambutolinduced psychosis researchgate. Isoniazid definition of isoniazid by medical dictionary. Isoniazid and ethambutolinduced psychosis open access library. Isoniazid comes as a tablet and a solution liquid to take by mouth without food. Thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. If the address matches an existing account you will receive an email with instructions to reset your password. Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent above hivaids.
Tuberculosis tb is the leading infectious cause of mortality in people over 5 years of age, accounting for 6% of deaths worldwide. With the increasing prevalence of tuberculosis in the us, more people are expected to receive treatment for tuberculosis. Major toxic reactions are peripheral neuropathies at conventional dosage and seizures from overdosage. We describe the case of an 80yearold woman with mania. Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol emb induced psychosis being rare. Concurrentadministration of pyridoxinemay prevent neuropathy. Isoniazid and ethambutolinduced psychosis prasad r, garg r. Isoniazid induced psychosis in a patient on dots therapy. Cases of isoniazidrelated psychiatric disorders reported in the literature include psychosis, obsessivecompulsive neurosis, and mania. Psychiatric evaluation during hospital recovery found the patient neither actively suicidal nor psychotic. Side effects associated with the treatment of multidrugresi. It inhibits the cytochrome p450 system and hence acts as a source of free radicals.
Isoniazid, as part of dots regimen, is the first line of drug and very. We report a case of classical mania and peripheral neuropathy in a patient diagnosed with extensively drug resistant pulmonary tuberculosis. Thus, patients with isoniazid induced psychosis recover without specific treatment after the. Drugs such as isoniazid, cycloserine, ethambutol and flouroquinolones used in the treatment of tuberculosis have been reported to produce drug induced psychosis. Weirdorn and ervin 3 reported on five cases of inh induced acute psychosis. The current case establishes neuropathy with vitamin b6 deficiency. 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. Mania induced by isoniazid preventive therapy during. Antipsychotic drugs 9 chapter objectives after studying this chapter, you will be able to 1. In 1996, tiwari reported a case of isoniazid induced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Antituberculous therapy was now restarted, with ethambutol, rifampicin, and pyrazinamide. Data sourcesinformation about the patient was obtained from the medical chart. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset. Isoniazid is bactericidal to rapidly dividing mycobacteria, but is bacteriostatic if the mycobacteria are slowgrowing.
Drug interactions, adverse effects, and use in special situations. An initial diagnosis of drug induced psychosis was made after a thorough screening for organincity and a psychiatric consultation, with isoniazid being identified as the likely culprit. Table 5 psychiatric morbidity and other factors affecting. These symptoms included depression, anxiety, nightmares, and psychotic. Treatment for isoniazid induced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11. Although druginduced liver injury dili caused by different drugs is somewhat different, the clinical characteristics of inhinduced liver injury. Aluminumcontaining antacids may decrease absorption.
The first is that isoniazid acts as a monoamine oxidase mao. Slow inactivation of isoniazid is prob ably an autosomal recessive trait and people with this have higher blood levels of the free compound than autosomal dominant rapid inactivators. The patient completely became free of psychotic symptoms over the next. Cases of isoniazid related psychiatric disorders reported in the literature include psychosis, obsessivecompulsive neurosis, and mania. Cases of isoniazid related psychiatric disorders reported in the. Inhibition of isoniazid induced hepatotoxicity in rabbits by pretreatment with an amidase inhibitor. Case report antitubercular druginduced violent suicide of.
Blurred vision or loss of vision, with or without eye pain. Isoniazid induced psychosis self harm behaviour with. Isoniazidinduced psychosis in a patient on dots therapy masood i. Toxic psychosis as a psychiatric side effect during antituberculosis therapy occurred when isoniazid was given in dose ranging from 2. 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. Read isoniazid, reactions weekly on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Case report isoniazid induced hepatitis and psychosis in a. The symptoms of dil include fever, elevated blood pressure, skin lesions, inflammation of the heart and lungs and arthritis.
We describe the case of a 21yearold black woman, with no prior psychiatric history, who developed a psychotic episode four days after she was started on isoniazid. Isoniazid can cause drug induced lupus dil when taken over longterm and chronic use. Isoniazid tablets isoniazid dose, indications, adverse. She had received isoniazid preventative therapy during steroid treatment for rheumatoid arthritis and organising pneumonia for the previous 5 months. In view of patients history and clinical findings, an initial diagnosis of pulmonary tuberculosis with.
Highdose isoniazid induced mania a case report contributors. Apr 03, 2008 thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. The patients acute agitation was managed by 10mg of diazepam given iv and isoniazid was withdrawn. Discuss characteristics of phenothiazines and related antipsychotics. Pdf isoniazid induced psychosis a case report researchgate. Pdf on jan 1, 2000, rajpal s and others published isoniazid induced psychosis a case report find, read and cite all the research you need on researchgate.
We described a case of pure isoniazid induced delirium, not previously reported in literature. Pyridoxine deficiency may play a role in the pathogenesis of isoniazid induced psychosis. The administration of pyridoxine, which has been advocated for the prevention and treatment of isoniazid induced neurologic manifestations, failed to achieve desired results in isoniazid induced psychosis. Considering the efficacy of isoniazid and its role as a firstline treatment in. A case of isoniazidinduced delirium the journal of. The patient became free of psychotic symptoms over the next 2 days. Isoniazidassociated psychosis, general hospital psychiatry. 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. At home he was symptom free but not for long and he returned to us again with increasing pallor, anorexia, and recurrent fever after one month. 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. Acute psychosis induced by inh, especially when given as part of the dots regimen, has a variable presentation, and should always be kept.
The appearance of acute psychosis following administration of inh is most often seen in those who have an antecedent history of unstable personality, although it can occur in otherwise normal people. If this drug is being widely used, it is important for us to be aware of its dangers. Isoniazid preventive therapy and pregnancy outcomes in hivinfected women in the tshepiso cohort. She was symptom free on follow up after stopping the. Feb, 2019 the mechanism of isoniazid induced psychosis is not well understood, but isoniazid is known to interfere with several metabolic pathways essential for normal neuronal functioning. Reactions 1583, p651 9 jan 2016 drug induced psychosis. It may also be used for atypical types of mycobacteria, such as m. Cyp2e1 genotype and isoniazid induced hepatotoxicity in patients treated for latent tuberculosis. The psychotic symptoms resolved partially after isoniazid was discontinued and completely after treatment with olanzapine was begun. Isoniazid is a mild monoamine oxidase inhibitormaoi. Drugs such as isoniazid, cycloserine, ethambutol and. Isoniazidinduced psychosis adekola o alao, jennifer c. Other presumed toxic reactions are autonomic neuropathy.
Pyridoxine deficiency may play a role in the pathogenesis of isoniazidinduced psychosis. When isoniazid is required in patients who are already receiving phenytoin, the phenytoin dose has to be adjusted because isoniazid decreases its clearance. We performeda retrospective analysis of those patients in the literature and we report acase of isoniazid induced psychosis in a 42yearold man with schizophrenia andalcohol dependence. Letters a case of isoniazid induced delirium to the editor. For latent tuberculosis it is often used by itself. Homicide by a tuberculous prisoner possibly having drug induced acute delusional psychosis. Psychosis is a known complication of isoniazid therapy, although infrequent. Such a drug is isoniazid isonicotinic acid hydrazide. First is that both tb and psychosis share some common risk factors such as low socioeconomic status, with its associated sequel such as increased risk of alcohol and drug abuse, hiv infection, or direct physiological effects of the infection and, in some instances, complication of treatments as in cycloserine induced psychosis or levofloxacin. Such deficiency states maybe detected indirectly by measuring urinary metabolites of tryptophan. Inh has since been associated with two syndromes of hepatotoxicity. All the three received 300 mg of isoniazid daily for the management of pulmonary tuberculosis. Mania induced by isoniazid preventive therapy during steroid. Thus, patients with isoniazid inducedpsychosis recover without specific treatment after the withdrawal of the offending drug.
764 1034 156 1377 847 336 602 1537 1474 959 391 1546 1486 608 117 1366 661 606 1279 434 155 1342 1106 314 1466 953 1105 1105 33 1348