title: The use of psychoeducation for a patient with hepatitis C and psychiatric illness in preparation for antiviral therapy: a case report and discussion.
abstract: The standard of care treatment for chronic hepatitis C viral infection (HCV) is a combination of pegylated interferon alfa and ribavirin for 24-48 weeks according to the virus genotype. This therapy is known to have multiple neuropsychiatric side effects. A major concern when evaluating a patient for HCV treatment with a known history of a psychiatric disorder is the risk that the patient's psychiatric disorder will flare or become unmanageable. The possibility of precipitating depression, confusion, mania, psychosis, hallucinations, or suicidal ideation or attempt is frequently an obstacle to treatment. We present the case of a 50 year-old man with HCV and an extensive psychiatric history involving alcoholism, depression, and suicidality who participated in a psychoeducation group to help prepare him for treatment with pegylated interferon alfa/ribavirin therapy. Though the patient derived much benefit from the psychoeducation group, by the time of evaluation for HCV treatment two months after the group ended he had relapsed back into a depressive episode with suicidal thoughts. His acute psychiatric status made him unacceptable for pegylated interferon alfa/ribavirin therapy. Psychoeducation groups show promise for helping patients with chronic medical illness to be ready for and endure intensive medical treatment that has substantial psychiatric side effects. The challenge is to help patients overcome barriers to treatment, particularly psychosocial problems, because available treatments are increasingly effective.
authors.affiliation: Department of Psychiatry, Washington University, School of Medicine, 660 S. Euclid Avenue, Campus Box 8134, St. Louis, MO 63110, USA. hongb@psychiatry.wustl.edu
authors.forename: Barry A
authors.initials: BA
authors.lastname: Hong
authors.forename: Carol S
authors.initials: CS
authors.lastname: North
authors.forename: David E
authors.initials: DE
authors.lastname: Pollio
authors.forename: Anna
authors.initials: A
authors.lastname: Abbacchi
authors.forename: Christine
authors.initials: C
authors.lastname: Debold
authors.forename: Sunday A
authors.initials: SA
authors.lastname: Adewuyi
authors.forename: Mauricio
authors.initials: M
authors.lastname: Lisker-Melman
mesh_terms: D000223:Adaptation, Psychological; D000437:Alcoholism / Q000150:complications / Q000523:psychology; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001364:Awareness; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000523:psychology*; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D011340:Problem Solving; D011613:Psychotherapy / Q000379:methods*; D011615:Psychotherapy, Group / Q000379:methods; D011994:Recombinant Proteins; D012008:Recurrence; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use*; D012944:Social Support; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology; D059020:Suicidal Ideation
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin