The classic textbook clearly states that “isoniazid is used with caution or is contraindicated in persons with a history of psychiatric disease”. However, in recent years, whether isoniazid can be used for anti-tuberculosis treatment in psychiatric patients has become a controversial topic. Is isoniazid really not suitable for anti-tuberculosis treatment in TB patients with psychosis at all? The most on this issue, some scholars have made the following studies. For example, in 1991, Yuan Bingrong et al. conducted a double-blind controlled study on such patients treated with antipsychotic drugs, and observed the changes of psychiatric symptoms by combining different doses of isoniazid with placebo, and found that the psychiatric symptoms did not worsen when the patients took psychotropic drugs together with higher doses of isoniazid. Another example is that in 2003, Chen Wenzhong et al. also found that isoniazid not only did not have a serious effect on the psychiatric symptoms of schizophrenic patients, but also could increase the blood concentration of clozapine, and that isoniazid had an inhibitory effect on CYP1A2, and its application could slow down the induction of CYP1A2 subtype by rifampicin to a certain extent, which could play a role in stabilizing the blood concentration and efficacy of antipsychotic drugs to a certain extent. . Therefore, we believe that isoniazid can still be used as a safer anti-tuberculosis drug for psychiatric patients if used in combination with effective antipsychotic drugs.
Chen Wenzhong, Department of Psychiatry, Shanghai Mental Health Center