Dr. Ashok Kumar
Geriatrics
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My father has been a diabetic patient for the past 20 years. Six months ago, he got affected by pulmonary tuberculosis and got administered anti-TB drugs, and insulin was administered in the basal-bolus regimen. Now both TB and diabetes are well under control. For the past week, he takes only two drugs for TB, namely tablet Isokin 300 and tablet Pyzina 750 for TB, apart from tablet Glyciphage 500, tablet Cardivas CR 40, tablet Tazloc AM 80, and tablet Minipress XL 5 mg as suggested by the doctor. But, for the past month, I notice a change in his behavior. He has developed a sort of restlessness. He laughs childishly without caring about anything. He is developing an adamant attitude for example, he took a huge quantity of food at one go, without heeding our advice to eat slowly, and thereby a vomiting sensation developed. He is indifferent to everything now and seems to have no feelings of happiness, sadness, affection, or pain. He never listens to us and lives in his own world. This is more severe in the evenings and at night. His doctor mainly attributes this to stress and says he will be alright in due course when he entirely stops the TB drugs. Is this a side effect of the drugs or related to some other problem? Please help.
Hello,
Welcome to icliniq.com.
I understand your concern. From your description, I feel it is more than just stress. A simple thing such as stress cannot be attributed to these many complex symptoms. In my opinion, there are two possibilities that should be ruled out before calling it just stress.
1. Anti-TB drug-induced psychosis: INH (Isoniazid) is a well-known cause of such a presentation, and the presence of INH in the treatment protocol makes me suspect it is the cause of his behavior changes.
2. Frontal lobe damage: Many of his actions are indicative of disinhibitory behavior, which often arises from frontal lobe damage. I think a CT (computed tomography) scan should be done and the frontal lobe should be examined as his symptoms closely resemble those of frontal lobe damage.
I hope this helps you. Feel free to write back to me if you have more questions.
Thank you.
Patient's Query
Hello doctor,
With reference to the above, the doctor prescribed the tablet Etizola 0.5 mg twice a day. He was administered the tablet Alprax 0.5 mg once a day five years back. But it was stopped and may be due to the fact that he has developed attitudinal changes. Now my question is
1. Is it fine to take tablet Etizola 0.5 twice a day, and will it calm him?
2. Are side effects more severe, and will it become a habit?
3. After TB drugs are stopped whether this drug also can be stopped?
4. If this does not work, will it be cured or controlled by taking medicines for frontal lobe damage as advised by you?
5. Whether all TB patients get such anxiety-related disorders?
Kindly help.
Hi,
Welcome back to icliniq.com.
I understand your concern. I am glad that the tablet Etizola (Etizolam 0.25 mg) has been prescribed as your doctor suspected attitude and behavior change, an effect of tablet Alprazolam withdrawal.
1. Etizola is a tablet Benzodiazepine group of medication that calms down anxiety and restlessness or suppresses irritability to some extent. If it is due to tuberculosis (TB) drugs or due to tablet Alprazolam withdrawal, there is a possibility of a good response, but in case it is expected to be frontal lobe damage, there will be limited effect for a limited duration, if any.
2. Among the available Benzodiazepines, Etizolam is safer and lesser habit-forming than other medications. The habit formation potential is much less in comparison to the tablet Alprazolam.
3. There is a good possibility that TB drugs are the cause of the same. I often remove psychotropic medications after one month of completion of the TB drug course.
4. Frontal lobe damage needs to be confirmed using brain imaging such as a CT (computerized tomography) scan or MRI (Magnetic resonance imaging) of the brain. In addition, there is a need for a complete neurological examination to corroborate the laboratory report and CT scan findings. Once this is known, we need to identify the cause, as the outcome depends on multiple factors, including the cause of the problem. For example, infective causes have good outcomes, while degenerative causes have poor outcomes. Not all patients. Hardly 20 % of patients develop such symptoms.
Thank you.
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Geriatrics
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