title: Prevalence and impact of manic traits in depressed patients initiating interferon therapy for chronic hepatitis C infection.
abstract: OBJECTIVE
  To evaluate the impact of manic traits on adverse events in depressed hepatitis C patients initiating interferon therapy.
  
  
  BACKGROUND
  Interferon alpha therapy for hepatitis C can exacerbate preexisting depression. Bipolar disorder frequently presents as depressive symptoms that are indistinguishable from or misdiagnosed as major depressive disorder. The impact of bipolar disorder on adverse psychiatric events during therapy is unknown.
  
  
  METHODS
  A retrospective study was performed on consecutive patients initiating interferon therapy in the Hepatology clinic at a tertiary-care center between December 2004 and October 2007. All patients completed the Physicians Health Questionnaire (PHQ-9), a validated survey for major depressive disorder. Patients with a positive PHQ screen completed the Mood Disorders Questionnaire (MDQ), a validated screening tool for manic traits. Patients with a negative PHQ served as controls. All adverse psychiatric events were documented through retrospective record review for 6 months after interferon initiation.
  
  
  RESULTS
  A total of 165 patients were treated with interferon alpha. One hundred thirty-two (80%) had a negative PHQ (controls) and 33 had a positive PHQ. Forty-one (30%) of the control patients had adverse psychiatric events. Psychiatric events occurred in 8 of 22 (36%) patients with positive PHQ but negative MDQ; 8 of 11 (73%) with positive PHQ and positive MDQ had psychiatric adverse events. This finding was statistically significant compared with the control group (P=0.007). The overall sustained viral response rate was 58% and was not statistically significant among groups.
  
  
  CONCLUSIONS
  Baseline manic traits, as detected by the MDQ, were associated with high rates of adverse psychiatric events among individuals receiving antiviral therapy.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Lim
authors.forename: Jeff
authors.initials: J
authors.lastname: Olson
authors.forename: Atif
authors.initials: A
authors.lastname: Zaman
authors.forename: Jim
authors.initials: J
authors.lastname: Phelps
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Ingram
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000150:complications*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha