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.

The relationship between symptom burden and systemic inflammation differs between male and female athletes following concussion

“…As opposed to females, in the current study symptom severity was positively correlated with blood concentrations of IFN-γ in male athletes following SRC. This observation is generally supported by literature that has shown a positive association between the family of IFN proteins and symptoms such as headache, fatigue, irritability, hostility, and depression [34,38,39] in numerous maladies. While we found IFN-γ was associated with all symptom clusters, cognitive symptoms displayed the highest effect; in females cognitive symptoms displayed the lowest effect.…”

The relationship between symptom burden and systemic inflammation differs between male and female athletes following concussion.

“…As opposed to females, in the current study symptom severity was positively correlated with blood concentrations of IFN-g in male athletes after SRC. This observation is generally supported by literature that has shown a positive association between the family of IFN proteins and symptoms 10 such as headache, fatigue, irritability, hostility, and depression [31,35,36] in numerous maladies.…”

A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the “post-inflammatory brain syndrome” PIBS

“…IFN-a treatment for hepatitis C has a rate of depression that is up to 42% with malaise also being common. The rates of psychiatric side effects do not appear to differ based on previous psychiatric history (Spennati and Pariante, 2013). Depression is also associated with many acute phase markers and markers of T-cell activation.…”