Cycloserine-induced psychosis in patients with drug-resistant tuberculosis: a systematic review of case reports

Abstract Objectives To describe the clinical characteristics and outcomes of cycloserine (CS) - induced psychosis in adults diagnosed with drug-resistant tuberculosis (DR-TB). Materials and Methods A systematic review of case reports was carried out according to PRISMA guidelines. Subsequently, information was extracted concerning sociodemographic variables, clinical characteristics of psychosis, treatment, and clinical outcomes, as well as the quality of the articles using a standardized tool (Joanna Briggs Institute -JBI- Case Reports Tool). Results Of 3416 articles, 20 reports from seven countries were included, encompassing 22 patients (68.18% male participants, mean age: 31.45 ± 10.88 years). Delusions (68.20%, primarily paranoid) were the most frequent psychotic symptom. The median duration of the psychotic episode was 13 days (interquartile range: 35). Other frequently appearing symptoms in CS-induced psychosis were aggressiveness (68.20%), insomnia (59.10%), hallucinations (54.50%), incoherent/disorganized speech (45.45%) and irritability (45.45%). After antipsychotic treatment (81.81% of the reported cases were treated with at least one antipsychotic), 95.50% presented improvement, while 4.54% died by suicide. Finally, after the quality assessment of studies using the JBI tool, 85.00% of the articles showed a low risk of bias. Conclusions CS-induced psychosis is a rare presentation, generally of short duration, that includes delusions (mostly paranoid) as its main psychotic symptom and shows mostly a symptom improvement after medical treatment. PROSPERO registration number: CRD42022359551 (Date of registration: 22/09/2022)