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Free Content Psychiatric issues in the management of patients with multidrug-resistant tuberculosis

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INTRODUCTION: 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.

SETTING: 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.

CONCLUSION: Psychiatric comorbidities are not a contraindication to MDR-TB therapy. Management of psychiatric complications is possible without compromising anti-tuberculosis treatment.
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Keywords: Peru; anxiety; cycloserine; depression; multidrug-resistant tuberculosis; psychosis; review

Document Type: Regular Paper

Affiliations: 1: Neuropsychiatric Service, Department of Medicine, Ministry of Health, Lima, Peru 2: Socios En Salud, Lima, Peru 3: Socios En Salud, Lima, Peru; and Department of Health and Social Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru 4: Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, USA 5: Socios En Salud, Lima, Peru; and Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA

Publication date: June 1, 2004

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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