Interferon-Induced Psychosis as a “Psychiatric Contraindication” to Hepatitis C Treatment: A Review and Case-Based Discussion

• Published in: Psychosomatics (Washington, D.C.) D.C.), 2010-01, Vol.51 (1), p.1-7
• Main Authors: Silverman, Benjamin C., M.D, Kim, Arthur Y., M.D, Freudenreich, Oliver, M.D
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Antiviral Agents - adverse effects; Biological and medical sciences; Drug toxicity and drugs side effects treatment; Female; Hepatitis C - drug therapy; Humans; Interferons - adverse effects; Internal Medicine; Medical sciences; Miscellaneous (drug allergy, mutagens, teratogens...); Other psychotic disorders; Pharmacology. Drug treatments; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychoses; Psychoses, Substance-Induced - diagnosis; Psychoses, Substance-Induced - etiology; Psychoses, Substance-Induced - psychology; Psychosis; Ribavirin - adverse effects; Severity of Illness Index
• ISSN: 0033-3182; 1545-7206
• DOI: 10.1016/S0033-3182(10)70652-6

Background Hepatitis C (HCV) infection is a major cause of liver disease, cirrhosis, and hepatocellular carcinoma. Interferon-based treatments have the potential to decrease the burden of disease, but are complicated by side effects, including neuropsychiatric symptoms. Objective The authors described a case of interferon-induced psychosis as a framework to review the literature and discuss the decision to pursue antiviral treatment in psychiatrically ill patients with hepatitis C. Method The authors followed a patient with chronic HCV who received interferon and ribavirin and who developed hallucinations ultimately requiring psychiatric hospitalization. Results Despite treatment with various neuroleptics, the psychosis resolved only when the interferon/ribavirin were discontinued. Conclusion Psychiatric illness should not rule out the possibility of interferon-based therapy, but it calls for close integration of psychiatric and medical care and individualized decision-making based on the biological and psychosocial circumstances of each case.