Interferon-induced psychosis as a "psychiatric contraindication" to hepatitis C treatment: a review and case-based discussion.
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.


METHODS
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.


CONCLUSIONS
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.
Silverman
Benjamin C
BC
Wang Ambulatory Care Center, Massachusetts General Hospital, 15 Parkman St., Boston, MA 02114, USA. bcsilverman@partners.org
Kim
Arthur Y
AY
Freudenreich
Oliver
O
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects*; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000009:adverse effects*; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D012254:Ribavirin / Q000009:adverse effects*; D012720:Severity of Illness Index
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons