Schaefer Martin, Mauss Stefan
Department of Psychiatry and Psychotherapy, Kliniken Essen-Mitte, Ev. Huyssenstift, Essen, Germany.
Curr Drug Abuse Rev. 2008 Jun;1(2):177-87. doi: 10.2174/1874473710801020177.
60-90% of patients with intravenous drug abuse are chronically infected with the hepatitis C virus (HCV). Antiviral treatment with pegylated interferon-alfa (IFN-alpha) plus ribavirin is often complicated by psychiatric adverse events, significantly affecting patients adherence. Depression, anxiety, fatigue and irritability as typical IFN-alpha associated side effects occur in 30-80% during antiviral treatment of hepatitis C. Patients with drug addiction were shown to have an increased risk to discontinue HCV-treatment early in the first three treatment months, where most neuropsychiatric side effects appear. Especially vegetative side effects in the first few weeks ("flu-like syndrome") can be misunderstood as withdrawal symptoms, followed by a relapse in drug or alcohol abuse. As a consequence methadone substitution treatment was found to be the best therapeutic setting. In addition side effect management should be intensified during first three months of HCV-treatment. Most data for the management of specific IFN-alpha associated side effects are available for depressive syndromes. Antidepressants (especially serotonin-reuptake-inhibitors) such as citalopram were shown to significantly reduce IFN-alpha associated depressive symptoms. A pre-emptive treatment with antidepressants should be considered at least for patients with additional psychiatric risk factors before interferon-based therapy is started. Because data from prospective controlled trials are lacking, management of other side effects such as sleep disturbances, irritability, psychotic syndromes, mania, suicidal thoughts and delirious syndromes should follow general psychiatric treatment recommendations. Overall, the psychiatric adverse event profile of interferon-based therapy for HCV-infected patients with drug addiction is considerable and requires active management and knowledge about psychiatric medical therapy.
60%至90%的静脉注射吸毒患者长期感染丙型肝炎病毒（HCV）。聚乙二醇化干扰素-α（IFN-α）联合利巴韦林进行抗病毒治疗常伴有精神方面的不良事件，严重影响患者的依从性。抑郁、焦虑、疲劳和易怒等典型的与IFN-α相关的副作用在丙型肝炎抗病毒治疗期间发生率为30%至80%。研究表明，吸毒成瘾患者在治疗的前三个月早期中断HCV治疗的风险增加，而大多数神经精神方面的副作用在此期间出现。尤其是最初几周的植物神经副作用（“流感样综合征”）可能被误解为戒断症状，随后会出现药物或酒精滥用的复发。因此，美沙酮替代治疗被认为是最佳的治疗方案。此外，在HCV治疗的前三个月应加强副作用管理。关于特定的与IFN-α相关副作用管理的大多数数据都与抑郁综合征有关。抗抑郁药（尤其是5-羟色胺再摄取抑制剂）如西酞普兰已被证明可显著减轻与IFN-α相关的抑郁症状。至少对于有其他精神风险因素的患者，在开始基于干扰素的治疗前应考虑进行抗抑郁药的预防性治疗。由于缺乏前瞻性对照试验的数据，对于其他副作用如睡眠障碍、易怒、精神病综合征、躁狂、自杀念头和谵妄综合征的管理应遵循一般的精神科治疗建议。总体而言，对于HCV感染的吸毒成瘾患者，基于干扰素的治疗所产生的精神不良事件相当可观，需要积极管理并了解精神科药物治疗知识。
