Use of M/XDR-TB Regimen in Patients with Psychiatric Illness

There is a high baseline incidence of depression and anxiety in patients with Multidrug-resistant (MDR)/ Extensively Drug-resistant TB (XDR-TB) patients. Special precautions need to be taken for M/XDR-TB treatment-initiated patients suffering from pre-existing psychiatric illnesses.

Drugs Associated with Psychosis: Cycloserine (Cs), High-dose Isoniazid (H^h), Fluoroquinolone (FQ) and Ethionamide (Eto) 

Figure: Approach to M/XDR -TB patients on DR-TB regimen with psychiatric illness

Psychiatric emergencies include psychosis, suicidal ideation and any situation involving the patient being a danger to him/herself or others.​

When any patient on DR-TB treatment develops psychosis, they should be evaluated for other etiologies such as psychosocial stresses, depression, hypothyroidism, illicit drug and alcohol use.​

Resources​

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021. 
• WHO Consolidated Guidelines on Tuberculosis: Module 4 - Treatment: Drug-resistant TB Treatment, 2020.
• Technical and Operational Guidelines for TB In India, 2016.
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.

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