Withdrawing interferon-alpha from psychiatric patients: clinical care or unjustifiable stigma?

TY - JOUR

T1 - Withdrawing interferon-alpha from psychiatric patients

T2 - clinical care or unjustifiable stigma?

AU - Spennati, A.

AU - Pariante, C. M.

PY - 2013/6

Y1 - 2013/6

N2 - IFN-alpha 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-alpha, 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-alpha 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-alpha-induced psychiatric symptoms respond successfully to clinical management. We conclude that there is no support to withdrawing IFN-alpha therapy from psychiatric patients.

AB - IFN-alpha 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-alpha, 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-alpha 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-alpha-induced psychiatric symptoms respond successfully to clinical management. We conclude that there is no support to withdrawing IFN-alpha therapy from psychiatric patients.

KW - Cytokines

KW - depression

KW - hepatitis C

KW - immune

KW - inflammation

KW - interferon-alpha

KW - stigma

KW - CHRONIC HEPATITIS-C

KW - RIBAVIRIN THERAPY

KW - INDUCED DEPRESSION

KW - RISK

KW - SYMPTOMS

KW - COMORBIDITY

KW - COMPLETION

KW - DISORDERS

KW - UPDATE

KW - Acknowledged-BRC

KW - Acknowledged-BRC-13/14

U2 - 10.1017/S0033291712001808

DO - 10.1017/S0033291712001808

M3 - Editorial

SN - 0033-2917

VL - 43

SP - 1127

EP - 1132

JO - Psychological Medicine

JF - Psychological Medicine

IS - 6

ER -