Comprehensive Review of Hepatitis C for Psychiatrists: Risks, Screening, Diagnosis, Treatment, and Interferon-Based Therapy Complications

Crone, Catherine; Gabriel, Geoffrey M.

doi:10.1097/00131746-200303000-00002

Cited by 56 publications

(28 citation statements)

References 184 publications

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“…However, episodes of depression are a frequent side effect of IFN-α. These usually appear within 3 months after the start of treatment and affect the adherence of recipients to treatment and their quality of life [1,2,3,4,5]. …”

Section: Introductionmentioning

confidence: 99%

A Biopsychosocial Model of Interferon-Alpha-Induced Depression in Patients with Chronic Hepatitis C Infection

Baranyi¹,

Meinitzer²,

Stepan³

et al. 2013

Psychother Psychosom

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Background: The aim of this prospective study was to gain a more comprehensive picture of the biopsychosocial effects of interferon-α (IFN-α) treatment of patients with chronic hepatitis C (HCV). The predictors of depressive development and changes in health-related quality of life, life satisfaction and cognitive ability were measured with the inclusion of the social context. Furthermore, the effects of IFN-α treatment on indoleamine 2,3-dioxygenase, the level of tryptophan supply in the brain, the development of neurotoxic kynurenine metabolites and the thyroid glands were investigated. Therefore, for the first time the conditions for the development of depressive episodes in HCV patients treated with IFN-α were examined over the entire period of treatment as well as 3 months later, applying a holistic biopsychosocial model. Method: Psychiatric and biological assessments were carried out at 6 different times: before, during (at 1, 3, 6 and 9 months) and after the end of IFN-α treatment. Results: During IFN-α treatment 22 (53.7%) of 41 patients fulfilled the criteria for a treatment-related depressive disorder at least once during treatment. Contributing factors are tryptophan depletion (tryptophan to competing amino acids quotient), increased neurotoxic challenge (kynurenine to kynurenic acid quotient), less social support, female gender, preexisting psychiatric vulnerability, means of transmission, low financial security, impaired sexual satisfaction, small circle of friends, impaired physical role, strong body pain, low general health and vitality, reduced social functioning, impaired mental health and impaired emotional role. Conclusions: The awareness of relevant risk factors of IFN-α treatment-induced depression is essential to develop preventative treatment strategies.

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Section: Introductionmentioning

confidence: 99%

A Biopsychosocial Model of Interferon-Alpha-Induced Depression in Patients with Chronic Hepatitis C Infection

Baranyi¹,

Meinitzer²,

Stepan³

et al. 2013

Psychother Psychosom

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“…Recently a consensus was reached on the treatment of the HCV-infected, injection drug user (IDU) with pegylated interferon and ribavirin [1]. It is yet unclear as to whether these best-practice guidelines have been followed to good result due to multiple perceived barriers to treatment initiation.…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C treatment in drug users: an approach in terms of evidence-based medicine

et al. 2008

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“…Part of the interferon-induced depression phenomenology may include suicidality, making suicidality a treatment consideration before beginning therapy, and requires close monitoring during therapy [4] . Current or recent alcohol use has been another contra-indication: efficacy may be reduced in those drinking during treatment [6] and because those with a drinking history are perceived as having high risk of relapse under the distress of treatment [7] . Additionally, interferon therapies require that social circumstances needed to be assessed.…”

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confidence: 99%

What psychiatric screening and monitoring might be needed with the new generation of hepatitis C treatments?

Rowan

2015

WJV

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have emerged. These significantly boost the likelihood of sustained viral response, including for genotype 1, and do not seem to have the side effects of interferonalpha or ribavirin. Relevant data are reviewed to assess the degree that these new treatments might reduce the portion not eligible for treatment due to psychiatric comorbidities, and might reduce the emergence of psychiatric symptoms during treatment. Several organizations have recently released evidence-based treatment recommendation guidelines. It is apparent that interferon-alpha continues to be a standard of care, with the new drugs added to this recognized regimen in order to shorten treatment and to boost efficacy. Clinical settings must continue to assess appropriateness for treatment, including current or recent psychiatric comorbidities, and must continue to closely monitor patients for the emergence of psychiatric side effects. The newly developed hepatitis C treatments may affect the metabolism of several categories of psychiatric drugs, and so drug-drug interactions must also be considered and monitored. With many promising drugs under development, an all-pill regimen, with no interferon-alpha and no ribavirin, may emerge in the near future. This will greatly change the challenge of treatment decision-making, and should expand the portion of patients able to successfully complete a treatment regimen. Core tip: Emerging hepatitis C treatment regimens, which include newer medications such as boceprevir, telaprevir, sofosbuvir, and simeprevir, hold promise to reduce the need for psychosocial screening and monitoring. Thus far, these medications do not seem to have the same psychiatric side effect profile as interferon-alpha. AbstractPsychiatric difficulties, including depression and alcohol use disorders, pose a challenge to treatment decisionmaking for chronic hepatitis C. This is especially made worse because interferon-alpha, as part of the standard of care, may exacerbate depressive symptoms and cause suicidal symptoms to appear. This requires a treatment setting that has the capacity to carry out psychiatric assessment and monitoring, and the capability to deliver patient education regarding these aspects of care. Psychiatric comorbidities create a challenging decisionmaking situation, especially since success rates for the most common hepatitis C genotype, genotype 1, hover around 40%. In recent years, new treatments MINIREVIEWSSubmit a

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Comprehensive Review of Hepatitis C for Psychiatrists: Risks, Screening, Diagnosis, Treatment, and Interferon-Based Therapy Complications

Cited by 56 publications

References 184 publications

A Biopsychosocial Model of Interferon-Alpha-Induced Depression in Patients with Chronic Hepatitis C Infection

A Biopsychosocial Model of Interferon-Alpha-Induced Depression in Patients with Chronic Hepatitis C Infection

Hepatitis C treatment in drug users: an approach in terms of evidence-based medicine

What psychiatric screening and monitoring might be needed with the new generation of hepatitis C treatments?

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