Table 1 Included case report studies and their characteristics
Author and year of publication | AoP, sex and country | Main diagnosis | PMH | CS daily dose (in mg) | ATT | Psychotic symptoms | Other psychiatric symptoms | Duration of CS-induced psychosis (in days) | Treatment | Auxiliary examination and imaging procedures | Naranjo ADR score | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Shekhar et al., 2022 | 23, F, India | MDR tubercular chest wall abscess | None | 750 | CS, ethionamide, levofloxacin, ethambutol | Delusions (of persecusion, of reference) | Diminished appetite, emotional lability, disturbed sleep, suspiciousness, fearful affect and absent insight | 2 | ATT withhold (including CS), treatment with risperidone (2 mg/d) and lorazepam (2 mg/d). After 2d of treatment showed improvement | Hb: 11.2 g/dL, Leukocytes: 11000mm3, BUN: 21 mg/dL, Na+: 142 mEq/L, K+: 2.9 mEq/L, TSH: 2.32 μIU/mL, AST: 92 U/L, ALT: 82 U/L; cCT, cMRI, Thorax Rx, HIV-test: no anormalities detected | Probable | Symptom improvement (BPRS score improvement from 52 to 19 points in 1 month) |
Wazir et al., 2020 | 22, F, Malaysia | MDR-TB | None | Not reported | CS (after 9d stopped), isoniazide, ethionamide, rifampicine (after 40d stopped), pyrazinamide, moxifloxacin, kanamycin, PAS (suspended 2 times) | Hypersexuality (“she took off her clothes in presence of male and making kissing gestures”), psychomotor agitation, disorganized behavior | Emotional lability, aggressive behavior (e.g., shouting, yelling), irritability, elated mood | aprox. 90 | ATT withhold (including CS). Initially treatment w/haloperidol (1.5–3 mg/d), then olanzapine (20 mg/d) and valproic acid (800 mg/d) | cCT, LP: no anormalities detected | Possibled | Discharge against medical advice, psychotropic medication withhold after 3d discharge, symptom improvement (no BPRS or YMRS reported) |
Intini et al., 2019 | 48, F, India | Ganglionar MDR-TB | None | 500 | CS, kanamycin, ethionamide, clofazimine, linezolid, PAS and moxifloxacin | Hallucinations ns, “unsocial” behavior | Drowsiness, “depression”, social withdrawal, “impairment at work”, suicide attempts (3× from a 6th floor balcony) | 570 | CS withhold, steroids administrated (swelling in the right axilla, mg unknown) patient refused to take antipsychotics and took homeopathic treatments | Thorax Rx: no anormalities detected | Probabled | Symptom improvement (no BPRS or YMRS reported) |
Mahajan et al., 2017 | 36, M, India | MDR-TB | Hypothyroidism | 750 | CS, kanamycin, ethionamide, levofloxacin, ethambutol, pyrazinamide, pyridoxine | Disorganized speech (“irrelevant talking”), incoherent answers | Insomnia, drop attacks, “inability to do routine work”, vertigo | 60 | CS withhold and some ATT switched, treatment with olanzapine (2.5 mg/d) and lorazepam (2 mg/d) | Hb: 10.6 g/dL, Leukocytes 14,000 mm3, ESR: 30 mm/h, BUN: 34, Creatinine: 1.1 mg/dL, AST: 22 IU/mL, ALT:25, TSH: 25.6 μIU/mL, T3:1.02 ng/mL, T4: 5.6 ng/mL, HIV-Test negative | Probable | Symptom improvement (no BPRS or YMRS reported; HAMD/HAMA at the beginning: 18/13) |
Çakmak et al., 2016 | 38, M, Turkey | Skeletal MDR-TB (spondylodiscitis) | None | 1000 | CS, ethambutol, pyrazinamide, PAS, thioacetazone | Persecutory delusions (“family were trying to harm him or poison him”), visual hallucinations, hypersexuality | Accelerated speech, insomnia, suspiciousness, irritability, stereotypical behavior (“licking and sucking his lips”) | 14 | ATT withhold (including CS), treatment w/olanzapine (20 mg/d) | EEG: slow and dysrhythmic activity in temporal lobe; biochemical analysis, cMRI, thorax Rx, LP: no anormalities detected | Probabled | Symptom improvement (YMRS from 44 to 2) |
Jain et al., 2016 | 24, F, New Zealand | MDR-TB | None | 750 | CS, moxifloxacin, amikacin, prothionamide, PAS, pyridoxine | Persecutory delusions | Labile mood, hypervigilance, daytime somnolence, change in personality, suicidal ideation | 14 | CS discontinued cycloserine and initiated clofazamine 50 mg. No antipsychotic treatment was given | cMRI: bilateral hyperintensity in cerebellar hemispheres (dentate nuclei and adjacent white matter); CBC, biochemical analysis, thorax Rx, LP: no anormalities detected | Probabled | Partial symptom improvement (persistent low grade labile mood and psychotic symptoms). Resolution of cMRI anormalities |
Kennedy et al., 2016 | 22, M, Nigeria | MDR-TB, tubercular abscess neck and groin | None | 750 | CS, rifampicin, isoniazid, ethionamide, ofloxacin and streptomycin | Persecutory and grandiose delusions, visual hallucinations, disorganized speech (“irrational talks”), psychomotor agitation | Accelerated speech, irritable-aggressive behavior, insomnia, refusal to eat, restlessness, euphoria, absent insight | 3 | CS was discontinuated; Nitrazepam (2.5 mg/d), Vitamin B complex | CBC, electrolyte, urea and Cr and urinalysis, thyroid function test, HIV-test: no anormalities detected | Probable | Within 48 h BPRS reduction from 62 to 33; within 72 h marked symptom improvement |
Okpataku et al., 2015 | 26, M, Nigeria | MDR-TB | None | 500 | CS, pyrazinamide, proteonamide, kanamycin, levofloxacin and vitamin B6 | Persecutory delusions, acoustic and visual hallucinations | Insomnia, verbal aggressiveness, restlessness, social withdrawal, blunted affect | 12 | CS was maintained; treatment with haloperidol (10 mg/d) and benzhexol (5 mg/d) | Leukocytes: 41,000 mm3, HCT: 41%; biochemical analysis, HIV-test: no anormalities detected | Probable | Symptom improvement after treatment. New psychotic episode 5 weeks after hospital discharge and antitubercular treatment (7 weeks) |
Sawant et al., 2015 | 33, F, India | MDR-TB | None | 750 | CS, kanamycin, levofloxacin, ethionamide and pyridoxine | Delusional jealousy | Irritability, aggressive behavior (not specified), appetite loss | 60 | Changes in CS treatment were not specified, but recommended; treatment with haloperidol (1.5–10 mg/d), benzhexol (4 mg/d) and olanzapine (5–30 mg/d) | Leukocytes: 12,000 mm3, CPK: 1650 UI, BUN: 10 mg/dL, serum Cr: 1.2 mg/dL, myoglobine in urine; hepatic enzymes, cMRI, thorax Rx, LP: no anormalities detected. Results were obtained during the NMS developed by the patient | Probable | Symptom improvement, however, patient developed NMS |
Holla et al., 2015 | 42, M, India | MDR-TB | Family history of bipolar disorder and MDD | 750 | CS, levofloxacin, kanamcyin, ethionamide, pyrazinamide, ethambutol, pyridoxine | Persecutory delusions, hallucinations ns, disorganized speech with monologues, disorganized behavior, apathic | Logorrhea, crying, insomnia, irritability, constant suicidal ideations, suicide attempts (2–3), emotional lability, mood swings, verbal aggressive behavior, restlessness, social withdrawal, fearful | 194 | CS was stopped immediately; treatment first with quetiapine (25 mg/d), then olanzapine (20 mg/d) | Not reported | Probable | Symptom improvement (no BPRS or YMRS reported) |
Tandon et al., 2015 | 45, M, India | MDR-TB | None | 500 | CS, kanamycin, levofloxacin, ethionamide, pyrazinamide, pyridoxine | Disorganized speech | Aggressive behavior (verbal), anxiety, restlessness, insomnia, loss of interest (work, family and clothes), appetite loss | 7 | CS suspended. Treatment with haloperidol (10 mg/d), promethazine (50 mg/d), olanzapine (20 mg/d), nitrazepam (20 mg/d) and thiamine (300 mg/d) | Hb: 8.2 g/dL, Leukocytes 18,000 mm3, Glucose: 80 mg/dL, ESR: 42 mm/h, BUN: 23 mg/dL, serum Cr: 0.5 mg/dL, serum bilirubin: 5.4 mg/dL, AST: 192 mg/dL, ALT: 202 mg/dL, HIV-Test negative; thorax X-ray: bilateral fibrotic lesions in upper zones, ultrasonography abdomen and computed tomography scan: no anormalities detected | Probable | Symptom improvement (BPRS 3rd day: 33, no post-value), patient showed hepatic dysfunction during treatment |
Behera et al., 2014 | 25, M, India | MDR-TB | 2 suicide attempts (hanging, jumping from a 1st floor) | Not reported | CS, ethionamide, ethambutol, levofloxacin, pyrazinamide | Visual and acoustic hallucinations (“reported of a sense of machines moving and talking inside his brain”), disorganized speech (“incoherent speech, abnormal talk”) | Insomnia, anxiety symptoms (not described), abnormal whistling sounds in the ears | 32 | CS withhold; treatment with risperidone and clonazepam (doses not specified) | Not reported | Possibled | Violent suicide with multiple self-injuries with a knife to the chest and abdomen |
Arias, G et al., 2014 | 22, M, Peru | MDR-TB | Alcohol, cocaine and cannabis consumptiona | 750 | CS, amikacin, PAS, pyrazinamide, ethambutol, ciprofloxacin | Persecutory delusions, delusions of reference, acoustic hallucinations | Irritability, aggressive behavior (verbal) | 5 | CS withhold; treatment with haloperidol (3 mg/d) | Not reported | Probable | Symptom improvement (BPRS or YMRS not specified) |
Sharma et al., 2014 | 20, F, India | Meningeal MDR-TB | None | 750 | CS, levofloxacin, isoniazide, rifampicine | Persecutory delusions, delusions of reference, hallucinations ns, disorganized speech (“talking irrelevantly”) and behavior (monologues) | Irritability, aggressive behavior (verbal), accelerated speech | 3 | CS suspended; treatment with quetiapine (25 mg/d) | (Before psychosis) ESR elevated, LP: increased proteins (140 mg%), increased cell number (80 cells, 90% lymphocytes); cMRI: no anormalities detected | Probable | Symptom improvement (BPRS or YMRS not specified) |
Otu et al., 2014 | 28, M, Nigeria | MDR-TB | None | 750 | CS, pyrazinaminde, kanamycin, levofloxacin, prothionamide, pyridoxine | Persecutory delusions with negativism, disorganized behavior (monologues), visual and acoustic hallucinations | Aggressive behavior (physical), appetite loss, insomnia | 9 | CS reduction (500 mg/d); treatment initially with diazepam, chlorpromazine, haloperidol and benzhexol; then chlorpromazine withholds and olanzapine was added (doses not specified) | (Before psychosis) Hb: 11.6 g/dL, thorax Rx: fibrotic strands in the left upper lung zone with diffuse pulmonary infiltrates in the left middle and lower lung zones; other routinary evaluations were unremarkable | Probabled | Symptom improvement (BPRS or YMRS not specified) |
Bakhla et al., 2013 | 21, M, India | Ganglionar MDR-TB | Meningeal TB | 500 | CS, ethionamide, ofloxacin, streptomycin | Delusions of grandeur, psychomotor agitation (“increased psychomotor activity”) | Logorrhea, elated affect, decreased need for sleep, irritable-aggressive behavior (not specified), increased energy, overfamiliarity, and inflated self-esteem | 10 | CS withhold; treatment with valproic acid (750 mg/d) and olanzapine (5 mg/d) | Not reported | Probable | Symptom improvement (at beginning: YMRS of 38, BPRS of 51; after 3d: YMRS of 15, BPRS of 33; after 10d: no sign of manic symptoms) |
Sarkar et al., 2011 | 18, M, India | MDR-TB | None | Not reported | CS, kanamycin, pyrazinamide, ofloxacin, ethionamide and ethambutol | Persecutory delusions, delusions of reference, visual and acoustic hallucinations, disorganized behavior (monologues) | Insomnia, appetite loss, social withdrawal, anxious and fearful appearance, neglect of personal hygiene, reduced psychomotor activity with increased reaction time | 14 | CS was maintained; treatment with olanzapine (10 mg/d) | Not reported | Possibled | Symptom improvement (no BPRS or YMRS reported) |
Fujita et al., 2008 | 45, M, Japan | MDR-TB | Alcoholb and tobacco consumption (12.5 py) | 500 | CS, ethionamide, kanamycin, pyrazinamide, PAS, gatifloxacin | Self-disorders (“my other self is trying to help me”), disorganized speech (“I'm obsessed with something bad”), derealization (“Is it real or not?”) | “Abnormal” behavior (not specified), “gradually” worsened | 30 | CS withhold, no psychopharmacologic treatment given | Hb 11.4 g/dL, leukocytes 6080/µL, platelets 334,000/µL, AST: 15 IU/L, ALT 18 IU/L, LDH 110 IU/L, serum bilirubin 0.4 mg/dL, BUN 14 mg/dL, Cr: 0.75 mg/dL, ESR 46 mm/h, thorax Rx: bilateral upper lobe radiopacities, thorax CT: cavities in both upper lobes; cMRI, LP, HIV-test: no abnormalities detected | Possibled | Symptom improvement (BPRS or YMRS not specified) |
Bankier et al., 1965 | 31, M, Canada | Right renal TB | Alcohol usec, family history of alcoholism | 250 | CS, streptomycin, PAS, isoniazide | Persecutory delusions, delusions of grandeur, disorganized speech | Aggressive behavior (physical), restlessness, flat affect, judgement impairment, depersonalization (“a feeling of strangeness about his body, as if his brain was changed”) | 4 | CS suspended; treatment with chlorpromazine (400 mg/d) | BUN: 13 mg/dL, Glucose: 116 mg/dL; CBC, urine test, EEG and ECG: no abnormalities detected | Probabled | Symptom improvement (BPRS and YMRS not reported) |
Dunga et al., 2015 | 48, F, Nigeria | MDR-TB | DM | 500 | CS, kanamycin, prothionamide, levofloxacin, pyrazinamide and pyridoxine | Persecutory delusions, hallucinations ns, disorganized behavior (“irrational”) | Social withdrawn, suspiciousness, aggressive behavior (not specified), and insomnia | 3 | CS temporal withholding for 72 h; treatment with chlorpromazine (100 mg/d), haloperidol (10 mg/d) and benzhexol (10 mg/d) | CBC, HIV-test, biochemical analysis, glucose, liver enzymes and renal parameters: no anormalities detected | Probable | Symptom improvement (BPRS and YMRS not reported) |
23, M, Nigeria | None | 500 | CS, capreomycin, prothionamide, levofloxacin, pyrazinamide and pyridoxine | Disorganized speech (“irrelevant talk”, “unusual claims”), psychomotor agitation | Insomnia | 14 | CS temporal withholding (72 h); treatment with chlorpromazine (200 mg/d), risperidone (10 mg/d) and haloperidol (10 mg/d) | Probable | ||||
52, M, Nigeria | DM | 500 | CS, capreomycin, prothionamide, levofloxacin, pyrazinamide and pyridoxine | Persecutory delusions, visual and acoustic hallucinations, disorganized speech ("talked irrationaly") | Social withdrawn, logorrhea, aggressive behavior (destructive, violent) | 4 | CS dose temporarily reduced (250 mg) and increased back; treatment with chlorpromazine (200 mg/d), risperidone (10 mg/d), haloperidol (10 mg/d) | Probable |