Research progress on psychological and psychiatric adverse reactions induced by antituberculosis drugs

doi:10.19982/j.issn.1000-6621.20250063

Abstract

Abstract:

China is one of the countries with a high tuberculosis (TB) burden, with a large patient population. Currently, the primary treatment for TB is chemotherapy with anti-TB drugs. However, due to the prolonged treatment duration and the complexity of multidrug regimens, adverse reactions are inevitable. Among these, psychiatric and psychological adverse reactions are relatively common. However, they are often overlooked in clinical practice due to their insidious onset and the lack of specific diagnostic tools and evaluation criteria. This article reviews the latest research progress on the incidence, risk factors, related drugs and their mechanisms, as well as management strategies for psychiatric and psychological adverse reactions induced by anti-TB drugs, aiming to provide theoretical evidence and practical guidance for the early detection and intervention of such adverse reactions.

Key words: Antitubercular agents, Drug toxicity, Mental disorders, Review literature as topic

CLC Number:

Wang Yutong, Liu Yuhong, Li Liang. Research progress on psychological and psychiatric adverse reactions induced by antituberculosis drugs[J]. Chinese Journal of Antituberculosis, 2025, 47(7): 947-953. doi: 10.19982/j.issn.1000-6621.20250063

References 61

[1]	American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Worcester: American Psychiatric Association, 2022.
[2]	Johnson DA. Drug-induced psychiatric disorders. Drugs, 1981, 22(1):57-69. doi:10.2165/00003495-198122010-00004. pmid: 6114850
[3]	夏愔愔, 詹思延. 国内抗结核药物不良反应发生率的综合分析. 中华结核和呼吸杂志, 2007, 30(6): 419-423. doi:10.3760/j.issn:1001-0939.2007.06.007.
[4]	Imam F, Sharma M, Khayyam KU, et al. Adverse drug reaction prevalence and mechanisms of action of first-line anti-tubercular drugs. Saudi Pharm J, 2020, 28(3): 316-324. doi:10.1016/j.jsps.2020.01.011. pmid: 32194333
[5]	Furin JJ, Mitnick CD, Shin SS, et al. Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis, 2001, 5(7): 648-655. pmid: 11467371
[6]	Shin SS, Pasechnikov AD, Gelmanova IY, et al. Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia. Int J Tuberc Lung Dis, 2007, 11(12): 1314-1320. pmid: 18034952
[7]	石富国, 古明, 马世平. 一线主要抗结核药不良反应分布特点文献分析. 中国药物警戒, 2011, 8(7): 434-437. doi:10.3969/j.issn.1672-8629.2011.07.016.
[8]	王聪慧, 世伟, 阿拉腾花. 内蒙古2021年抗结核药物不良反应报告分析. 北方药学, 2023, 20(3): 194-196. doi:10.3969/j.issn.1672-8351.2023.03.065.
[9]	高利臣, 曹仕鹏, 鲁虹, 等. 121例二线抗结核药品不良反应分析. 中国感染控制杂志, 2018, 17(12): 1070-1074. doi:10.3969/j.issn.1671-9638.2018.12.008.
[10]	Vega P, Sweetland A, Acha J, et al. Psychiatric issues in the management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis, 2004, 8(6):749-759. pmid: 15182146
[11]	Nahid P, Mase SR, Migliori GB, et al. Treatment of drug-resistant tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. Am J Respir Crit Care Med, 2019, 200(10): e93-e142. doi:10.1164/rccm.201909-1874ST.
[12]	Pachi A, Bratis D, Moussas G, et al. Psychiatric morbidity and other factors affecting treatment adherence in pulmonary tuberculosis patients. Tuberc Res Treat, 2013, 2013:489865. doi:10.1155/2013/489865.
[13]	Dhingra VK, Rajpal S, Aggarwal N, et al. Adverse drug reactions observed during DOTS. J Commun Dis, 2004, 36(4): 251-259.
[14]	Wiedorn WS, Ervin F. Schizophreniclike psychotic reactions with administration of isoniazid. AMA Arch Neurol Psychiatry, 1954, 72(3): 321-324. doi:10.1001/archneurpsyc.1954.02330030055005. pmid: 13196751
[15]	Lewis WC, Calden G, Thurston JR, et al. Psychiatric and neurological reactions to cycloserine in the treatment of tuberculosis. Dis Chest, 1957, 32(2): 172-182. doi:10.1378/chest.32.2.172. pmid: 13447774
[16]	Lovenberg WM, Robinson DS. Albert Sjoerdsma. Neuropsychopharmacology, 2015, 40(13): 3061. doi:10.1038/npp.2015.303. pmid: 26548765
[17]	Pallone KA, Goldman MP, Fuller MA. Isoniazid-associated psychosis: case report and review of the literature. Ann Pharmacother, 1993, 27(2):167-170. doi:10.1177/106002809302700205. pmid: 8439690
[18]	Holdiness MR. Neurological manifestations and toxicities of the antituberculosis drugs. A review. Med Toxicol, 1987, 2(1):33-51. doi:10.1007/BF03259859. pmid: 3547005
[19]	Gülbay BE, Gürkan OU, Yildiz OA, et al. Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis. Respir Med, 2006, 100(10):1834-1842. doi:10.1016/j.rmed.2006.01.014.
[20]	Prasad R, Singh A, Gupta N. Adverse drug reactions in tuberculosis and management. Indian J Tuberc, 2019, 66(4):520-532. doi:10.1016/j.ijtb.2019.11.005. pmid: 31813444
[21]	梁荣发, 黄星炯, 黄彩葵. 异烟肼引起精神失常2例. 华夏医学, 2015, 28(1): 160-162.
[22]	胡月琴, 王燕燕. 异烟肼致精神异常1例. 中国临床药理学杂志, 2013, 29(4): 305-306. doi:10.3969/j.issn.1001-6821.2013.04.020.
[23]	段名珍. 利福平引起神经精神症状一例报告. 中华结核和呼吸杂志, 1988, 11(5): 313.
[24]	于庆海, 王立新, 郭惠芳. 利福平致精神异常1例. 临床荟萃, 2006, 21(17): 1277-1277. doi:10.3969/j.issn.1004-583X.2006.17.038.
[25]	Yen YF, Chung MS, Hu HY, et al. Association of pulmonary tuberculosis and ethambutol with incident depressive disorder: a nationwide, population-based cohort study. J Clin Psychiatry, 2015, 76(4):e505-11. doi:10.4088/JCP.14m09403.
[26]	Martin SJ, Bowden FJ. Ethambutol toxicity manifesting as acute onset psychosis. Int J STD AIDS, 2007, 18(4):287-288. doi:10.1258/095646207780658863. pmid: 17509184
[27]	Hsu CW, Chu KA, Lu T, et al. Ethambutol-induced psychosis: a case report. Zhonghua Yi Xue Za Zhi (Taipei), 1999, 62(10):724-727.
[28]	Schade S, Paulus W. D-Cycloserine in neuropsychiatric diseases: a systematic review. Int J Neuropsychopharmacol, 2016, 19(4): pyv102. doi:10.1093/ijnp/pyv102.
[29]	Intini E, Kishore G, Richeldi L, et al. Neuropsychiatric reactions induced by cycloserine in the treatment of multidrug-resistant tuberculosis: what an Indian female patient tells us. BMJ Case Rep, 2019, 12(12):e230993. doi:10.1136/bcr-2019-230993.
[30]	Bakhla AK, Gore PS, Srivastava SL. Cycloserine induced mania. Ind Psychiatry J, 2013, 22(1):69-70. doi:10.4103/0972-6748.123636. pmid: 24459378
[31]	Sharma B, Handa R, Nagpal K, et al. Cycloserine-induced psychosis in a young female with drug-resistant tuberculosis. Gen Hosp Psychiatry, 2014, 36(4):451.e3-4. doi:10.1016/j.genhosppsych.2014.03.009.
[32]	Pang Y, Liu R, Song Y, et al. High Incidence of Psychiatric Disorders Associated with Cycloserine Treatment of Multidrug-Resistant Tuberculosis Patients: A Cohort Study in Beijing, China. Infect Drug Resist, 2022, 15:3725-3732. doi:10.2147/IDR.S369715. pmid: 35859910
[33]	范玉美, 李凫坚, 吴俐敏. 含环丝氨酸方案治疗耐多药肺结核引起精神神经等不良反应观察. 中华临床感染病杂志, 2014, 7(3):230-234. doi:10.3760/cma.j.issn.1674-2397.2014.03.009.
[34]	Bankier RG. Psychosis associated with cycloserine. Can Med Assoc J, 1965, 93(1):35-37.
[35]	Mulhall JP, Bergmann LS. Ciprofloxacin-induced acute psychosis. Urology, 1995, 46(1):102-3. doi:10.1016/S0090-4295(99)80171-X. pmid: 7604468
[36]	Dey SK. Nightmare due to ciprofloxacin in young patients. Indian Pediatr, 1995, 32(8):918-920. pmid: 8635840
[37]	Zaudig M, von Bose M, Weber MM, et al. Psychotoxic effects of ofloxacin. Pharmacopsychiatry, 1989, 22(1):11-15. doi:10.1055/s-2007-1014570. pmid: 2710806
[38]	Hollweg M, Kapfhammer HP, Krupinski M, et al. Psychopathological syndromes in treatment with gyrase inhibitors. Nervenarzt, 1997, 68(1):38-47. doi:10.1007/s001150050094. pmid: 9132619
[39]	Lees AW. Ethionamide and isoniazid in previously untreated cases of pulmonary tuberculosis. Dis Chest, 1964, 45:247-250. doi:10.1378/chest.45.3.247. pmid: 14132269
[40]	Narang RK. Acute psychotic reaction probably caused by ethionamide. Tubercle, 1972, 53(2):137-138. doi:10.1016/0041-3879(72)90031-1. pmid: 5040576
[41]	Sharma GS, Gupta PK, Jain NK, et al. Toxic psychosis to isoniazid and ethionamide in a patient with pulmonary tuberculosis. Tubercle, 1979, 60(3):171-172. doi:10.1016/0041-3879(79)90019-9. pmid: 516171
[42]	World Health Organization. WHO consolidated guidelines on drug-resistant tuberculosis treatment. Geneva: World Health Organization, 2019.
[43]	Zhang Q, Liu Y, Tang S, et al. Clinical benefit of delamanid (OPC-67683) in the treatment of multidrug-resistant tuberculosis patients in China. Cell Biochem Biophys, 2013, 67(3):957-963. doi:10.1007/s12013-013-9589-5. pmid: 23546935
[44]	高孟秋, 高静韬, 马晓格,等. 含德拉马尼方案治疗我国耐多药和利福平耐药肺结核患者的阶段性不良反应临床分析. 中华结核和呼吸杂志, 2024, 47(7):638-646. doi:10.3760/cma.j.cn112147-20240229-00117.
[45]	Blair HA, Scott LJ. Delamanid: a review of its use in patients with multidrug-resistant tuberculosis. Drugs, 2015, 75(1): 91-100. doi:10.1007/s40265-014-0331-4. pmid: 25404020
[46]	Madan A, Jain NK, Sharma TN, et al. Attempted suicide following treatment with isoniazid. Tubercle, 1989, 70(2):147-149. doi:10.1016/0041-3879(89)90041-x. pmid: 2617689
[47]	Tai DY, Yeo JK, Eng PC, et al. Intentional overdosage with isoniazid: case report and review of literature. Singapore Medical Journal, 1996, 37(2): 222-225. pmid: 8942271
[48]	Farberow L, McKelligott JW, Cohen S, et al. Suicide among patients with cardiorespiratory illnesses. JAMA, 1966, 195(6):422-428.
[49]	Furin JJ, Mitnick CD, Shin SS, et al. Occurrence of serious adverse effects in patients receiving community-based therapy for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis, 2001, 5(7):648-655. pmid: 11467371
[50]	Patel AM, McKeon J. Avoidance and management of adverse reactions to antituberculosis drugs. Drug Saf, 1995, 12(1):1-25. doi:10.2165/00002018-199512010-00001.
[51]	Sant Anna FM, Araújo-Pereira M, Schmaltz CAS, et al. Impact of adverse drug reactions on the outcomes of tuberculosis treatment. PLoS One, 2023, 18(2): e0269765. doi:10.1371/journal.pone.0269765.
[52]	张宏, 戴莉玲, 邹青. 异烟肼所致精神异常文献概述. 中国药物滥用防治杂志, 2014(5): 292. doi:10.3969/j.issn.1006-902X.2014.05.013.
[53]	Wiedorn WS, Ervin F. Schizophreniclike psychotic reactions with administration of isoniazid. AMA Arch Neurol Psychiatry, 1954, 72(3): 321-324. doi:10.1001/archneurpsyc.1954.02330030055005. pmid: 13196751
[54]	Tandon VR, Rani N, Roshi, et al. Cycloserine induced psychosis with hepatic dysfunction. Indian J Pharmacol, 2015, 47(2):230-231. doi:10.4103/0253-7613.153439.
[55]	Schrestha S, Alao A. Isoniazid-induced psychosis. Psychosomatics, 2009, 50(6):640-641. doi:10.1176/appi.psy.50.6.640-a. pmid: 19996240
[56]	Gottlieb JD, Cather C, Shanahan M, et al. D-cycloserine facilitation of cognitive behavioral therapy for delusions in schizophrenia. Schizophr Res, 2011, 131(1-3):69-74. doi:10.1016/j.schres.2011.05.029. pmid: 21723096
[57]	Lane HY, Huang CL, Wu PL, et al. Glycine transporter Ⅰ inhibitor, N-methylglycine (sarcosine), added to clozapine for the treatment of schizophrenia. Biol Psychiatry, 2006, 60(6):645-649. doi:10.1016/j.biopsych.2006.04.005.
[58]	Tsai G, Lane HY, Yang P, et al. Glycine transporter Ⅰ inhibitor, N-methylglycine (sarcosine), added to antipsychotics for the treatment of schizophrenia. Biol Psychiatry, 2004, 55(5):452-456. doi:10.1016/j.biopsych.2003.09.012.
[59]	Evins AE, Amico E, Posever TA, et al. D-Cycloserine added to risperidone in patients with primary negative symptoms of schizophrenia. Schizophr Res, 2002, 56(1/2):19-23. doi:10.1016/s0920-9964(01)00220-1.
[60]	Yurgelun-Todd DA, Coyle JT, Gruber SA, et al. Functional magnetic resonance imaging studies of schizophrenic patients during word production: effects of D-cycloserine. Psychiatry Res, 2005, 138(1):23-31. doi:10.1016/j.pscychresns.2004.11.006.
[61]	Sweetland AC, Galea J, Shin SS, et al. Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors. Int J Tuberc Lung Dis, 2019, 23(5):600-605. doi:10.5588/ijtld.18.0530. pmid: 31097069