Successful treatment of psychosis induced by interferon alpha and ribavirin with paliperidone: first case reported

Abstract

Several clinical studies have shown a large number of mental symptoms by immunomodulatory treatment with interferon (IFN). The most frequently described symptoms are depression, suicidal behaviour, manic symptoms, anxiety, psychosis and delirium, associated with other non-specific symptoms such as fatigue, irritability, psychomotor retardation, decreased libido, insomnia, difficulty in concentration and attention. Having a history of mental disorder contraindicates the use of IFN-alpha. These adverse effects that affect the mental state appear usually at the beginning of the treatment (most after 3 weeks of treatment). The incidence of psychotic episodes is low and the episodes usually remit when treatment is interrupted; only some cases require antipsychotic treatment. We present the case of a patient affected with hepatitis C who began to present self-referential delirious symptoms after receiving the treatment with IFN and who was successfully treated with paliperidone. This patient could be classified within the group of high-risk psychiatric patients given the family history of schizophrenia and his personal history of illegal drug consumption. The pharmacological actions of paliperidone are similar to other high potency atypical antipsychotics. The receptor-binding profile of paliperidone most closely resembles that of risperidone and ziprasidone. Paliperidone differs from risperidone and most other antipsychotics by its relatively low extent of enzymatic hepatic metabolism. To the best of our knowledge, this is the first case described that was successfully treated with paliperidone.

Detailed Postmortem Profiling of Inflammatory Mediators Expression Revealed Post-inflammatory Alternation in the Superior Temporal Gyrus of Schizophrenia

“…Several reports have revealed no significant differences between schizophrenia and controls in terms of plasma IFN-α levels ( 23 , 24 ). However, from a clinical point of view, it has been known that IFN-α treatment is strongly associated with mental symptoms such as depression and psychosis ( 25 , 26 ). Thus, elevated endogenous IFN-α levels in the chronic phase of schizophrenia may be the common biological change that causes depression.…”

Treatment of Patients With Schizophrenia and Comorbid Chronic Hepatitis With Paliperidone: A Systematic Review

“…It is known to have minimal hepatic metabolism [ 3 ]. It is a drug that is well tolerated in patients with impaired hepatic function and does not have metabolic drug interactions [ 9 ].…”

“…So, schizophrenia should not stop a person from taking anti-viral therapy when infected with the hepatitis C virus [ 11 ]. A case report by Carrillo de Albornoz Calahorro et al [ 9 ] evaluated the treatment preferred in patients suffering from psychosis due to interferon and ribavirin therapy (used for viral hepatitis). They concluded that since most antipsychotics are metabolized by the liver, a drug that has the least hepatic metabolism should be preferred so that there is the least possible hepatic damage.…”

“…They concluded that since most antipsychotics are metabolized by the liver, a drug that has the least hepatic metabolism should be preferred so that there is the least possible hepatic damage. They used paliperidone as their drug of choice in such a situation [ 9 ].…”

“…No relevant studies have found paliperidone to cause hepatotoxicity to such an extent [ 8 ]. A study by Carrillo de Albornoz Calahorro et al [ 9 ] states that no dose adjustment is required in patients with mild or moderate hepatic impairment. In the same study, it was also stated that patients with stable active hepatic disease who have schizophrenia or schizoaffective disorder tolerate paliperidone effectively [ 9 ].…”