Psychiatric issues in the management of patients with multidrug-resistant tuberculosis.
BACKGROUND
Psychiatric issues present a challenge in the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs and psychosocial factors require aggressive management.


METHODS
A community-based non-governmental health organization in Lima, Peru.


OBJECTIVE
To review the literature for psychiatric complications associated with anti-tuberculosis medications, to describe the incidence and prevalence of depression, anxiety and psychosis among individuals receiving MDR-TB therapy, and to detail the management approach used in this cohort.


METHODS
A retrospective case series was performed among the first 75 patients to receive individualized MDR-TB therapy in Lima, Peru, between 1996 and 1999.


RESULTS
Baseline depression and baseline anxiety were observed in respectively 52.2% and 8.7% of this cohort. Most individuals with baseline depression experienced improvement of depressive symptoms during the course of TB therapy. The incidence of depression, anxiety and psychosis during MDR-TB treatment was 13.3%, 12.0% and 12.0%, respectively. While the majority of individuals with depression, anxiety and psychosis required psychiatric pharmacotherapy, cycloserine was successfully continued in all but one case.


CONCLUSIONS
Psychiatric comorbidities are not a contra-indication to MDR-TB therapy. Management of psychiatric complications is possible without compromising anti-tuberculosis treatment.
Vega
P
P
Neuropsychiatric Service, Department of Medicine, Ministry of Health, Lima, Peru.
Sweetland
A
A
Acha
J
J
Castillo
H
H
Guerra
D
D
Smith Fawzi
M C
MC
Shin
S
S
D000328:Adult; D017677:Age Distribution; D000904:Antibiotics, Antitubercular / Q000009:adverse effects* / Q000627:therapeutic use; D001007:Anxiety / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D003523:Cycloserine / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007406:Interview, Psychological; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects; D010568:Peru / Q000453:epidemiology; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*
D000904:Antibiotics, Antitubercular; D003523:Cycloserine