Sakamoto H, Inoue K, Shimada M, Yoshida H, Otsubo T, Miyaoka H, Kamizima K, Ishii M, Mitamura K
Department of Urology, Showa University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 2000 Sep;91(9):611-7. doi: 10.5980/jpnjurol1989.91.611.
Depression is well known as one of the psychiatric complications of interferon (IFN) therapy in patients with chronic active hepatitis C. We compared the psychiatric status during interferon therapy between patients with renal cell cancer (RCC) and those with chronic active hepatitis C.
The psychiatric status of 40 patients with renal cell cancer, 36 who were subjected to radical nephrectomy and 4 who were not because of the presence of distant metastasis and other complicated underlying diseases, was assessed by psychiatrists before and at 2, 4, 12 and 24 weeks after the start of IFN therapy according to the major depressive episode diagnostic criteria listed in the DSM-III-R and the Hamilton Depression Scale (HDS). The mental aspect was measured using the Eysenk Personality Questionnaire (EPQ) before IFN therapy, and the results were compared with those obtained in 85 hepatitis C patients evaluated according to the same protocol for psychiatric assessment.
Eight of the 40 patients were diagnosed as having depression before IFN therapy and 5 of them became even more depressed 2 weeks after the start of IFN therapy. Nine patients were found to be depressed after the start of IFN therapy, 7 of them were diagnosed before 4 weeks of therapy. All the patients needed treatment for depression: discontinuation of IFN therapy in 4, decrement of the IFN dose in 8, and psychiatric drug medication in 13. The patients who suffered from depression had significantly higher scores in neuroticism (EPQ) before IFN therapy than those who did not become depressed. There was no difference in age, sex or cancer stage between the two groups. The occurrence of depression in RCC patients was the same as that observed in hepatitis C patients receiving IFN therapy. But in RCC patients the depressive state was diagnosed earlier and was more severe than that observed in hepatitis C patients.
Urologists should be aware of the psychiatric symptoms of RCC patients under IFN therapy just as in hepatitis patients. The depression in RCC patients was considered to be related to the cancerous disease itself which may explain its higher degree of severity, as compared to hepatitis C patients.
抑郁症是慢性丙型肝炎患者接受干扰素（IFN）治疗时常见的精神并发症之一。我们比较了肾细胞癌（RCC）患者与慢性丙型肝炎患者在干扰素治疗期间的精神状态。
40例肾细胞癌患者，其中36例行根治性肾切除术，4例因存在远处转移及其他复杂基础疾病未行手术，在IFN治疗开始前以及治疗开始后2周、4周、12周和24周，由精神科医生根据《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中列出的重度抑郁发作诊断标准及汉密尔顿抑郁量表（HDS）对其精神状态进行评估。在IFN治疗前使用艾森克人格问卷（EPQ）测量心理方面，将结果与85例按照相同精神评估方案评估的丙型肝炎患者的结果进行比较。
40例患者中有8例在IFN治疗前被诊断为患有抑郁症，其中5例在IFN治疗开始后2周病情加重。9例患者在IFN治疗开始后被发现患有抑郁症，其中7例在治疗4周前被诊断。所有抑郁症患者均需接受治疗：4例停用IFN治疗，8例减少IFN剂量，13例使用精神科药物治疗。在IFN治疗前，患抑郁症的患者在神经质（EPQ）方面的得分显著高于未患抑郁症的患者。两组在年龄、性别或癌症分期方面无差异。RCC患者抑郁症的发生率与接受IFN治疗的丙型肝炎患者相同。但RCC患者的抑郁状态诊断更早且比丙型肝炎患者更严重。
泌尿外科医生应像关注肝炎患者一样，意识到接受IFN治疗的RCC患者的精神症状。RCC患者的抑郁症被认为与癌症疾病本身有关，这可能解释了与丙型肝炎患者相比其严重程度更高的原因。
