Major depressive disorder with psychotic features induced by interferon-α treatment for hepatitis C in a polydrug abuser

Abstract

Infectious diseases, especially hepatitis C, are prevalent among drug abusers. Interferon-alpha (IFN-α) is the pharmacological treatment of choice for this condition. Patients being treated with IFN-α can be expected to experience such psychiatric side-effects as development of depression, mania, irritability, changes in personality, hallucinations or delirium. In addition, certain patients are considered to be at greater risk of developing neuropsychiatric side-effects. Individuals meeting the following criteria are particularly vulnerable: over 40 years of age; having central nervous system abnormalities; a previous neurological or psychiatric history; a past familial psychiatric history; use of narcotics or having alcohol or substance use disorders; being HIV-positive; coadministration of other cytokines; receiving high doses of IFN-α (> 6 million units). We report the case of a 29-year-old patient with chronic non-active hepatitis C, a previous psychiatric history of polydrug abuse (cannabis, heroin and illegal use of the psychotropic drug biperiden) and anxiety disorder. Two weeks after the initiation of IFN-α treatment, he developed fatigue, sleeplessness and persecutory delusions. The patient responded partially to the discontinuation of the IFN-α treatment. Due to the presence of three risk factors in this patient, he was considered to belong to the group of patients being ‘at high risk’ of developing neuropsychiatric side-effects. This is the first case report of major depressive disorder with psychotic features in such a ‘high-risk patient’. This case report may prompt other research by showing the importance of the close monitoring, and the prevention of the progression of IFN-α-related psychiatric disorders in ‘a high-risk patient’.