Occurrence of psychiatric disorders in the patients of multi drug resistant tuberculosis under treatment

Anand Kumar, Dhananjay Chaudhari, Rahul Anand, Sanjay Kumar Verma, Avdhesh Kumar, Sudhir Chaudhri


Background: Tuberculosis (TB) is considered as one of the leading causes of mortality worldwide. Even though fatality of TB is well known, treatment non-adherence is major barrier related to management of TB. Studies have shown that there is strong association between psychiatric disorders and treatment nonadherence to TB. Psychiatric issues present a challenge in the treatment of patients with multi drug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs require aggressive management for better management of TB. The objective of the present endeavour was to study the occurrence of psychiatric complications in patients of MDR-TB during treatment

Methods: Patients of MDR-TB registered at PMDT centre situated at a tertiary level hospital were screened for psychiatric disorder by using GHQ-12 and assessment was done using structured clinical interview for DSM-IV-TR (SCID-1) research version. Diagnosis of psychiatric disorder was made on the basis of DSM-IV-TR.

Results: Psychiatric disorders were already present in 8 (6.15%) patients before the start of MDR-TB treatment and development of psychiatric disorder in 12 (9.23%) patients after initiation of the treatment. Depressive disorder (n=9; 6.9%), anxiety disorder (n=5; 3.8%) and psychosis (n=4; 3.1%) were most frequent psychiatric disorders.

Conclusions: GHQ-12 was found to be very useful screening instrument for detection of psychiatric disorders. The regimen IV anti tubercular drugs used for the treatment of MDR-TB drug resistant tuberculosis, significantly increases the risk of development of psychiatric disorders. 


General health questionnaire, Multi drug resistance tuberculosis, Psychiatric disorders, Prevalence

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World Health Organization, Global Tuberculosis Control 2010, World Health Organization, Geneva, Switzerland, 2010. Available at http://

Wiedorn WS, Ervin F. Schizophrenic-like psychotic reactions with administration of isoniazid. Arch Neurol Psychiatry. 1954 Sep 1;72(3):321-4.

Lewis WC, Calden G, Thurston JR, Gilson WE. Psychiatric and neurological reactions to cycloserine in the treatment of tuberculosis. Dis Chest. 1957 Aug 1;32(2):172-82.

Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012 Dec 15;380(9859):2197-223.

Gnam W, Flint A, Goldbloom D. Isoniazid-induced hallucinosis: response to pyridoxine. Psychosomatics. 1993 Nov 1;34(6):537-9.

Alao AO, Yolles JC. Isoniazid-induced psychosis. Ann Pharmacotherapy. 1998 Sep;32(9):889-91.

Lansdown FS, Beran M, Litwak T. Psychotoxic reaction during ethionamide therapy. Am Rev Resp Dis. 1967 Jun;95(6):1053-5.

Holmes TH, Hawkins NG, Bowerman CE, Clarke Jr ER, Joffe JR. Psychosocial and psychophysiologic studies of tuberculosis. Psychosomatic Med. 1957 Mar 1;19(2):134-43.

Kim YJ, Cho MJ, Park S, Hong JP, Sohn JH, Bae JN, et al. The 12-item general health questionnaire as an effective mental health screening tool for general Korean adult population. Psychiatry Investigation. 2013 Dec 1;10(4):352-8.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-IV-TR. Washington DC: American Psychiatric Association. 2000.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

Yadav BS, Jain SC, Sharma G, Mehrotra ML, Kumar A. Psychiatric morbidity in pulmonary tuberculosis. Indian J Tuberculosis. 1980;27(4):167-71.

Gupta LN, Bhatia BL, Godara RC, Vyas JN, Singhal S. Life events, physical illness and psychiatric morbidity. Indian J Psychiatry. 1981 Oct;23(4):338.

Tandon AK, Jain SK, Tandon RK, Asare R. Psychosocial study of tuberculosis patients. Indian J Tub. 1980;17.

Vega P, Sweetland A, Acha J, Castillo H, Guerra D, Fawzi S, et al. Psychiatric issues in the management of patients with multidrug-resistant tuberculosis. Int J Tuberculosis Lung Dis. 2004 Jun 1;8(6):749-59.