Psychiatric Symptoms in Patients With Chronic Hepatitis C Receiving Interferon Alfa-2b Therapy
J Clin Psychiatry 2003;64:708-714
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Psychiatric side effects of
interferon alfa are frequently observed in the therapy of
patients with chronic hepatitis C infection. The goal of the
present study was to assess prospectively the incidence,
spectrum, and extent of psychiatric symptoms of patients
receiving interferon alfa therapy as compared with an untreated
Method: 104 patients with chronic
hepatitis C were consecutively enrolled in a prospective
longitudinal study. The treatment group (N = 84) received
interferon alfa-2b for up to 12 months, and the reference group
(N = 20) received no treatment. Patients who began treatment
between November 1996 and August 1998 (N = 44) received
interferon alfa-2b, 5 million units 3 times per week. Patients
who began treatment in September 1998 or later (N = 40) received
a combination of interferon alfa-2b, 3 to 5 million units 3 times
per week, and ribavirin, 1000-1200 mg/day. Diagnostic scores for
depression and anxiety were obtained by means of the psychometric
instrument Hospital Anxiety and Depression Scale, and scores for
anger/hostility were obtained with the Symptom Checklist-90
Results: In contrast to the untreated
reference group, we found significantly increased scores for
depression (p < .001) and anger/hostility (p < .001) during
interferon alfa therapy in the treatment group. Even before
therapy, scores of those in the treatment group were above the
respective cutoff values for clinically relevant symptoms of
depression in 15.5% of the patients, anxiety in 13.1% of the
patients, and anger/hostility in 11.3% of the patients. These
proportions rose to 35.0% (depression), 25.6% (anxiety), and
24.5% (anger/hostility). The cumulative frequency of clinically
relevant emotional distress (depression, anxiety, or
anger/hostility) during interferon alfa therapy was 57.7%, as
compared with 22.5% before therapy. However, interferon alfa
therapy had to be stopped prematurely because of untreatable
psychiatric symptoms in only 8.3% of patients.
Conclusion: In view of the high frequency
and extent of psychiatric symptoms with interferon alfa therapy,
we recommend a close follow-up of patients receiving this therapy
with respect to potential limiting mood changes.