Isoniazid induced psychosis pdf files

Psychosis is a word used to describe medical conditions that affect the brain, so that what a person thinks is real is different from what other people think is real. When this occurs, it is called a psychotic episode. Sometimes these symptoms will rapidly resolve as the effects of the substances wear off. Jul 29, 2019 patients given isoniazid should be carefully monitored and interviewed at monthly intervals. Psychotic mental illnesses are of major social and public health importance. Treatment for isoniazidinduced psychosis includes discontinuation of isoniazid 10, 12, addition of an antipsychotic 6, 7, or a combination of both 5, 9, 11. Thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. Isoniazid is the most reliable and most commonly used medication for tuberculosis.

A large portion of the worlds population is infected with tb. Isoniazid preventive therapy and pregnancy outcomes in hivinfected women in the tshepiso cohort. Dosage adjustments are often required based on patient age, renal and hepatic function, etc. 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. Isoniazid undergoes extensive metabolism that takes place in the mucosal cells of the small intestine and in the liver. Compare characteristics of atypical antipsychotic drugs. Isoniazidinduced acute psychosis in a patient with pleural. Antipsychotic drugs 9 chapter objectives after studying this chapter, you will be able to 1. Isoniazid inh is an antibiotic used to treat infection with mycobacterium tuberculosis tb. Highdose isoniazid induced mania a case report contributors. About 3 percent of the population is at risk for psychosis, making the onset of psychosis more common than many severe, chronic diseases in youth, including type i diabetes. 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. Discuss characteristics of phenothiazines and related antipsychotics. 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.

Isoniazid induced psychosis self harm behaviour with neuropathy and vitamin b6 deficiency. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. Isoniazid inh inhibits the phosphorylation of pyridoxine and chelates whatever pyridoxal phosphate remains. What you need to know about your medicine for latent. 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. People with liver dysfunction are at a higher risk for hepatitis caused by inh, and may need a lower dose. Among the traditional forms of firstline antituberculosis. In one study, concomitant use with isoniazid decreased isoniazid exposure by 2230%. Isoniazid preventive therapy in hivinfected pregnant and postpartum women.

Isoniazid as part of directly observed treatmentshort course dots regimen is universally used. Isoniazid should be used with caution in patients with seizure disorders, a history of psychosis or hepatic impairment. History of liver damage or chronic alcohol ingestion. Public health service surveillance study of,838 persons taking isoniazid, there were 8 deaths among 174 cases of hepatitis. The first is that isoniazid acts as a monoamine oxidase mao.

The presumed mechanism of inh induced seizure involves a decrease in the availability of gaba, which is the major inhibitory neurotransmitter in the central nervous system cns, as well as a relative increase in the amounts of glutamate, the primary excitatory neurotransmitter. Gi disturbance was most pronounced after treatment with ethambutol and. Aug 29, 2012 nervous system toxicity with current antituberculosis pharmacotherapy is relatively uncommon, although the frequency of the usage of antituberculosis therapy requires that physicians be aware of such toxicity. Inh metabolites directly inhibit pyridoxine phosphokinase. First isoniazid is inactivated through acetylation. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Isoniazid induced psychosis i ip is well reported with varied clinical presentations.

If this drug is being widely used, it is important for us to be aware of its dangers. Scholars elective, university of western ontario, 1994 thesis submitted in partial fulfillment of the requirements for the degree of. 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. Isoniazid is an antibacterial recommended for all forms of tuberculosis in which organisms are susceptible. When isoniazid is to be taken 2 times a week, it should be given by directly observed therapy dot. Although a majority of drug induced psychosis cases stem from stimulant use or abuse, there are plenty of other drugs besides stimulants that can cause psychosis. All the three received 300 mg of isoniazid daily for the management of pulmonary tuberculosis.

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. Isoniazidinduced psychosis in a patient on dots therapy. Isoniazid and ethambutolinduced psychosis prasad r, garg. Antituberculosis therapy manifests both central and peripheral nervous system effects, which may compromise patient compliance. Isoniazid is an antibacterial available as a solution for oral administration. The current case establishes neuropathy with vitamin b6 deficiency as a possible cause for iip warranting early clinicians. Substance induced psychosis and criminal responsibility by michelle s. Isoniazid side effects, dosage, interactions drugs. Isoniazid can cause drug induced lupus dil when taken over longterm and chronic use.

Patients should be carefully monitored for isoniazid toxicity. The symptoms of dil include fever, elevated blood pressure, skin lesions, inflammation of the heart and lungs and arthritis. We report a case of classical mania and peripheral neuropathy in a patient diagnosed with extensively drug resistant pulmonary tuberculosis. 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. Psychotic illnesses include schizophrenia, bipolar disorder and major depression. Tuberculosis drug information guide curry international. Active tuberculosis must be treated with multiple concomitant antituberculosis medications to prevent the emergence of drug resistance. 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. Because pyridoxal phosphate is a cofactor that is important to the gaba system, it has been hypothesized that the centrally diminished gaba activity may relate to the pathophysiology of isoniazid. The current case establishes neuropathy with vitamin b6 deficiency. The concomitant occurrence of inh and emb induced psychosis and in a single individual is extremely uncommon. A case of mania is rarely reported in this context. Drugs such as isoniazid, cycloserine, ethambutol and.

Drug induced psychosis use of, or withdrawal from alcohol and drugs can be associated with the appearance of psychotic symptoms. Avoid tyraminerich foods such as mature cheeses, salami, pickled herring, bovril, oxo, marmite or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines or histaminerich foods such as very mature cheese or fish from the scromboid family e. This product also contains as inactive ingredients. In 1996, tiwari reported a case of isoniazidinduced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Take isoniazid at around the same time every scheduled day. Isoniazid dosage adjustments may be required in rapid acetylators. Isoniazid and ethambutolinduced psychosis prasad r, garg r. Approximately three out of 100 people will experience an. Isoniazid daily every day 9 months twice weekly m t w th f s sun your doctor may have you take vitamin b6 with your medicine. Nervous system effects of antituberculosis therapy springerlink. Reactions 83 7 jan 2012 psychosis in an elderly patient. Isoniazidinduced acute psychosis in a patient with. Adverse effects include hepatitis, peripheral neurotoxicity, lupus like syndrome, and central nervous system effects including dysarthria, seizures, irritability and even psychosis 2. Although druginduced liver injury dili caused by different drugs is somewhat different, the clinical characteristics of inhinduced liver injury.

Many complications of the administration of isoniazid isonicotinic acid hydrazide. Dopamine hypothesis put forward by arvid carlsson the clinical features of schizophrenia sometimes extended to psychosis in general is. Apr 03, 2008 thus, patients with isoniazid induced psychosis recover without specific treatment after the withdrawal of the offending drug. One female and two male patients aged 35 years, 55 years and 60 years respectively developed psychosis following isoniazid administration.

Psychosis usually first appears in a persons late teens or early twenties. Notify the physician promptly if these symptoms develop see appendix d. Cognitive behavioural therapy for psychotic symptoms 7 introduction rationale for treatment since the 1950s, the usual firstline treatment for persons with chronic psychotic disorders has been neuroleptic medication. Isoniazid induced psychosis in a patient on dots therapy. Toxic psychosis as a psychiatric side effect during antituberculosis therapy occurred when isoniazid was given in dose ranging from 2. Discuss common manifestations of psychotic disorders, including schizophrenia. Aluminiumcontaining antacids may, delay absorption nd decrease serum concntrations o. In several registry studies alcohol induced psychosis was the most common subtype of substance induced psychosis, and had a lower probability of transition to schizophrenia. Concomitant use with isoniazid may increase the plasma concentrations of isoniazid. 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 is distributed in the body with an apparent volume of distribution volume of 0. Patients with diabetes should be carefully monitored, since blood glucose control may be affected by isoniazid. These include organic causes such as drug intoxication, metabolic and infective causes and functional disorders such as schizophrenia, bipolar disorder, schizophreniform psychosis and schizoaffective disorder. Cases of isoniazid induced psychiatric conditions reported in the literature include psychosis, obsessivecompulsive disorders, and mood alterations. Side effects associated with the treatment of multidrugresi. Be alert for signs of drug induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. A case of isoniazidinduced delirium the journal of.

Psychosis affects the way a person thinks, feels and behaves. A case of isoniazidinduced psychosis in a 42yearold man. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset. You may need to take other tb medicines in combination with isoniazid. When treating active tb, isoniazid must be used with other tb medicines. Such deficiency states maybe detected indirectly by measuring urinary metabolites of tryptophan. The symptoms of psychosis are often categorized as either positive or negative.

Significant cns disease, including seizure disorder, psychotic disease. The word psychosis is used to describe conditions that affect the mind, in which people have trouble distinguishing between what is real and what is not. Isoniazid definition of isoniazid by medical dictionary. A person who has a psychotic illness may have delusions, hallucinations, confused thinking and abnormal behavior. Isoniazid inh has been associated with neuropsychiatric side effects commonly peripheral neuropathy and psychosis. Drug induced psychosis most often occurs with those that abuse stimulants, which is why theres a subclassification known as stimulant psychosis.

People may also experience some cognitive and other symptoms. The association of isoniazid and psychosis was first highlighted by jackson in 1957. Tuberculosis can become resistant to treatment if isoniazid is used alone. Gi disturbance was most pronounced after treatment with ethambutol and pas. The psychosis resolved completely after completion of therapy for tuberculous meningitis and cessation of isoniazid. Less frequently, inh may be used as part of a combination regimen for nontuberculous mycobacterial infections. Many hypotheses are available to explain the mechanism of iip but lack conclusive evidence in its favour. Such a drug is isoniazid isonicotinic acid hydrazide. Isoniazid and rifampicin induced oxidative hepatic injuryprotection by nacetylcysteine.

Psychosis is a known complication of isoniazid therapy, although infrequent. Monitor psychosis or other alterations in mental status. Isoniazid is a medicine used alone or with other drugs to treat or prevent tuberculosis tb tb is an infectious disease that mainly impacts the lungs. Drugs such as isoniazid, cycloserine, ethambutol and flouroquinolones used in the treatment of tuberculosis have been reported to produce drug induced psychosis. Isoniazid inh is used for treatment of tuberculosis as part of combination therapy or for latent tuberculosis infection as monotherapy or part of combination therapy. Table 5 psychiatric morbidity and other factors affecting. Isoniazid, as part of dots regimen, is the first line of drug and very commonly used. The effectiveness of this type of treatment has brought about important improvements in the care and management of individuals. Isoniazidinduced psychosis adekola o alao, jennifer c yolles, 1998.

Adverse effects include hepatitis, peripheral neurotoxicity. Concurrentadministration of pyridoxinemay prevent neuropathy. Pdf isoniazid induced psychosis a case report researchgate. Side effects of isoniazid isoniazid, warnings, uses. Patients receiving both rifampicin and isoniazid should be monitored closely for hepatotoxicity. Aluminumcontaining antacids may decrease absorption. Acute psychosis after recent isoniazid initiation ncbi. In other cases, the illness may last longer, but begin with a drug induced psychosis. 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. Isoniazid is recommended as preventive therapy for certain individuals. 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. Therefore, patients given isoniazid should be carefully monitored and interviewed at monthl y intervals.

Cases of isoniazidrelated psychiatric disorders reported in the literature include psychosis, obsessivecompulsive neurosis, and mania. Isoniazid associated psychosis indian journal of pharmacy practice. He was prescribed rifampicin, pyrazinamide, and ofloxacin and had no further psychotic symptoms. In 1996, tiwari reported a case of isoniazid induced psychosis with disturbed sleep, restlessness, and abnormal behavior as in the present case. Apr 15, 2019 isoniazid is the hydrazide of isonicotinic acid. Daviss drug guide for rehabilitation professionals ciccone cd. When isoniazid is required in patients who are already receiving phenytoin, the phenytoin dose has to be adjusted because isoniazid decreases its clearance.

Read isoniazid, reactions weekly on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol emb induced psychosis being rare. Each 5 ml teaspoonful of syrup contains 50 mg of isoniazid. Substance induced psychosis and criminal responsibility. 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. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Pdf isoniazid and ethambutolinduced psychosis researchgate. Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent above hivaids. False beliefs strongly held false beliefs, such as the belief that a famous person is speaking directly to them through the television or radio, or that.

Getting help early can prevent a lifetime of pain and debilitation. Hence, it has become the point of interest in our case. Case report antitubercular druginduced violent suicide of. In view of patients history and clinical findings, an initial diagnosis of pulmonary tuberculosis with. Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug induced changes in peripheral nerve function. Isoniazid and ethambutolinduced psychosis open access library. Antipsychotic medication reference user guide usual dosage ranges represent treatment of schizophrenia in healthy adults unless otherwise indicated. This is the first case of isoniazidassociated psychosis reported in a child. Vitamin b6 is used to prevent isoniazid induced b6 deficiency and neuropathy in people with a risk factor, such as pregnancy, lactation, hiv infection, alcoholism, diabetes, kidney failure, or malnutrition. 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. An initial diagnosis of druginduced psychosis was made after a thorough screening for organincity and a psychiatric consultation, with isoniazid being identified. Isoniazid induced psychosis self harm behaviour with. Isoniazid and ethambutolinduced psychosis europe pmc.

Psychosis in tuberculosis may result as adverse effects of antituberacular drugs including isoniazid, ciprofloxacin, etambutol and rifampicin 2,3 or maybe a presenting complaints in cases of intracranial tuberculoma. These symptoms included depression, anxiety, nightmares, and psychotic. The experience of psychosis varies greatly from person to person. Pdf most cases of antituberculous agentassociated psychoses were caused by isoniazid inh, with ethambutol embinduced psychosis. Isoniazid is used to treat and to prevent tuberculosis tb. However, early intervention is showing promising results. Isoniazid injection usp provides 100 mg isoniazid per ml with 0.

Isoniazid syrup fda prescribing information, side effects. Isoniazid and ethambutolinduced psychosis open access. Psychosis can come on suddenly or can develop very gradually. Concurrent use of alcohol, palclcetamol and other hepatotoxic medication may increase the incidence ol rifampicin induced hepatotoxicity. Black and hispanicwomen, women in thepostpartum period,or patients 50 yr qriskof. Adverse events with 4 months of rifampin therapy or 9 months of isoniazid therapy for latent tuberculosis infection. Isoniazid has been found to be weakly mutagenic in strains ta 100 and ta 1535 of salmonella typhimurium ames assay without metabolic activation. Transition of substanceinduced, brief, and atypical.