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Abstract

Tolerance of interferon-a therapy for hepatitis C is often poor and medication is expensive. Compliance with diagnostic procedures and, even more important, with medical treatment is obviously critical to minimize the rate of dropouts and to maximize cost efficiency. Moreover, a good concordance with scheduled follow-ups is important for early recognition and treatment of interferon-associated side effects. Therefore, we investigated psychiatric symptoms, interpersonal problems, different modes of acquisition, and sociodemographic factors in HCV-infected patients as possible predictor variables of good versus poor compliance. In a longitudinal study, 74 patients with chronic hepatitis C (CHC) who fulfilled the criteria for treatment with interferon (IFN)-alpha-2b with or without ribavirin were investigated prospectively to identify those at risk for poor compliance during IFN medication. To assess predictive factors, we used both IIP-C (Inventory of Interpersonal Problems) and SCL-90-R (Symptom Check List 90 Items Revised) as psychometric instruments. Sociodemographic and somatic variables as well as compliance during IFN therapy were also evaluated. Poor compliance before or during medication was demonstrated by 23% (N = 17) of HCV patients. Sociodemographic factors and mode of acquisition, particularly former intravenous drug (IVD) abuse were not significantly linked with compliance. Logistic regression analysis demonstrated that the subgroup of patients with compliance problems was best identified by both pretherapeutic psychiatric symptoms and interpersonal problems. Predictive value was best and significant for anger-hostility (P = 0.009), intrusive (P = 0.014), depression (P = 0.015), and phobic anxiety (P = 0.049). Adopting this statistical prediction model, sensitivity was 47.1%, but specificity reached 98.3%. In total, 86.5% of cases were classified correctly. In situations of unclear indication for IFN therapy, psychological variables assessment of before the beginning of treatment may represent an additional decision-making factor.

Risk factors for the development of depression in patients with hepatitis C taking interferon-α

“…The additive effect would mean that this subset of patients would be more at risk of being diagnosed with a depressive disorder due to elevated scores on a depression rating scale. Should this be the case, then all patients would experience an increase in scores on a depression rating scale relative to time, which is something that much of the literature seems to support 23,25,104,108,111,113,114,125,128–134. In fact, some researchers have pinpointed a relative increase in somatic components of depressive rating scales as being primarily responsible for the increase in scores seen in many patients 46.…”

“…Depression is a particularly common side effect that may occur in up to 60% of patients,17,18 and in some rare cases, it may be associated with deliberate self-harm or suicide attempts 19,20. The neuropsychiatric side effects of IFN-α therapy are among the commonest causes of treatment discontinuation,21,22 and risk factors such as baseline psychiatric symptoms and interpersonal problems can predict poor compliance 23. Identification of the risk factors that lead to neuropsychiatric side effects and the associated low adherence rates may help identify patients at risk who may then benefit from additional psychological assessment and support.…”

Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms?

“…A recent study by Leutscher et al (2010) showed that 10% of CH-C patients treated with pegylated IFN and RBV had to prematurely withdraw from treatment, because 65% of them (most did not undergo antidepressant therapy) had developed major depression, which might adversely affect the outcome from HCV treatment. A number of earlier studies reported that anti-depressive treatment might optimize the outcome of HCV antiviral therapy, particularly by reducing the risk of early treatment discontinuation (Kraus et al, 2001; Maddock et al, 2004; Raison et al, 2005a). The recognition and treatment of pre-existing mental illness before HCV therapy yields improved tolerability and treatment response (Schaefer et al, 2007).…”

Hepatitis Infection in the Treatment of Opioid Dependence and Abuse

“…A prospective longitudinal study of 74 HCV-infected patients receiving interferon treatment, with and without ribavirin, found that adherence was not influenced by sociodemographic factors or source of hepatitis infection. In particular, a history of injection drug abuse was not linked significantly with compliance difficulties ( Kraus et al 2001 ).…”