Institute of Psychiatry, King's College London, Department of Psychological Medicine, London, UK.
Psychol Med. 2013 Jun;43(6):1127-32. doi: 10.1017/S0033291712001808. Epub 2012 Sep 14.
IFN-α 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-α, 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-α 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-α-induced psychiatric symptoms respond successfully to clinical management. We conclude that there is no support to withdrawing IFN-α therapy from psychiatric patients.
干扰素-α是治疗慢性丙型肝炎病毒的有效方法，目前仍然是一种有效的一线治疗方法。不幸的是，它的使用与许多副作用相关，包括抑郁、躁狂、精神病、谵妄和其他认知障碍等精神问题。临床医生一直担心加重先前存在的精神疾病和在精神科患者中诱发自杀企图的风险。因此，精神疾病的存在通常被认为是使用抗病毒治疗的禁忌症。然而，这相当于污名化和歧视，因为这基本上意味着因为一个精神科诊断而拒绝进行救命的医疗。这在临床上和社会上是否可以接受？随着新型治疗方法作为干扰素-α的辅助治疗方法进入临床实践，现在尤其需要明确表态，以确保精神科患者不会被落下。本社论的目的是通过回顾确实给患有先前存在的精神疾病的患者使用干扰素-α的少数研究（n=14），批判性地讨论这一概念。我们发现有证据表明，这些患者的治疗依从性和持续病毒学应答率与非精神科患者相似，并且他们的干扰素-α引起的精神症状对临床管理有反应。我们的结论是，没有理由从精神科患者中撤回干扰素-α治疗。
