title: Withdrawing interferon-α from psychiatric patients: clinical care or unjustifiable stigma?
abstract: IFN-α is an effective therapy for chronic viral hepatitis C and today still represents an effective first-line treatment. Unfortunately, its use is associated with a number of side-effects, including psychiatric problems like depression, mania, psychosis, delirium and other cognitive disturbances. Clinicians have been concerned about the risks of worsening of pre-existent psychiatric disorders and of precipitating suicidal attempts in psychiatric patients. The presence of a mental illness is, therefore, often deemed to be a contraindication to the use of antiviral treatment. However, this amounts to stigmatization and discrimination, as it basically implies withholding a life-saving medical treatment because of a psychiatric diagnosis. Is this clinically and socially acceptable? With novel treatments now entering clinical practice as adjuvant to IFN-α, it is particularly important to make a statement now, to ensure that psychiatric patients are not left behind. The aim of this editorial is to critically discuss this notion, by reviewing the few studies (n = 14) that have indeed administered IFN-α to patients with a pre-existing psychiatric disorder. We find evidence that these patients have rates of treatment adherence and sustained virological response similar to those of non-psychiatric patients, and that their IFN-α-induced psychiatric symptoms respond successfully to clinical management. We conclude that there is no support to withdrawing IFN-α therapy from psychiatric patients.
authors.affiliation: Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Spennati
authors.forename: C M
authors.initials: CM
authors.lastname: Pariante
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects; D000075202:Contraindications; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007371:Interferon-gamma / Q000009:adverse effects; D001523:Mental Disorders / Q000139:chemically induced / Q000150:complications*; D057545:Social Stigma
chemical_list: D000998:Antiviral Agents; D007371:Interferon-gamma