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