Psychosomatics 43:428-429, October 2002
© 2002 The Academy of Psychosomatic Medicine
Psychosis Induced by Interferon-
Gemma Garcia-Parés, M.D., Ph.D.,
Cristina Domenech, M.D., and
Montserrat Gil, M.D., Barcelona, Spain
TO THE EDITOR: Chronic liver disease due to hepatitis B and C viruses is known to respond to treatment with interferon- . Depression is the most common of its neuropsychiatric effects, occurring at a frequency of 3% to 50%, including cases of suicide.1–5 Nevertheless, some cases of mania and psychosis have been described.6–8
The latent period between administration of interferon- and the appearance of such effects can range from a few days after initiation to as late as several days after treatment has been completed. Clinical remission can be expected within 2 to 3 months at most after discontinuation of treatment. In such cases, any factor predisposing toward psychiatric disorders acts to promote the appearance of such side effects.1,9 The present clinical case describes a manifestation of disorganized psychosis associated with the initiation of interferon treatment.
Case Report
Mr. A was a 21-year-old man who had no psychiatric history of note or habits of substance abuse who developed psychotic symptoms a few months after starting interferon- treatment. He had a history of chronic liver disease due to hepatitis B virus, which studies indicate was probably acquired by means of vertical transmission. Interferon- treatment was initiated at a dose of 5 million IU/week. It was initially well tolerated; the only side effects were a slight weight loss and a certain degree of asthenia. Five months after the start of treatment, a clinical picture developed over the course of 1 week that consisted of psychic anxiety, psychomotor restlessness, emotional lability, behavioral and conceptual disorganization, disintegrated thought patterns with blocks, bewilderment, feelings of strangeness, depersonalization and derealization, self-referentialism, delirious interpretations, megalomaniac ideation, affective and volitional ambivalence, and experiences of existential change (uncertainty regarding sexual identity, hand dominance, visual ability, etc.). No changes were observed in sensory perception.
A neurological examination yielded normal findings. Laboratory analyses and serological tests revealed no relevant changes compared with previous findings. A cranial computed tomography scan gave no indication of any alterations. After the discontinuation of interferon, risperidone treatment was initiated, up to a dose of 6 mg/day. Clinical progress fluctuated initially; restitutio ad integrum was achieved 7 weeks after initiation, with Mr. A regaining a normal level of activity. He was observed to be calm and syntonic, with fluent, coherent speech and good emotional expression and made appropriate comments regarding his psychotic symptoms.
Discussion
The medical history, clinical presentation, and test results in the present case point to a psychotic disorder. The fact that the patient's premorbid adjustment was good, the absence of any personal or family history of psychiatric disease, the fact that the disorder arose during treatment, the rapid onset of symptoms in the absence of any stressful life events, and the manner of clinical presentation all suggested a causal relationship with the administration of interferon. Recovery to the former state, occurring within the time limits described in the literature for such cases, was also compatible with this hypothesis. However, it should be borne in mind that the onset of this clinical condition occurred at the age at which schizophrenic disorders usually appear, and this must therefore be included in the differential diagnosis. Definitive diagnosis will depend upon the patient's clinical progress; nevertheless, at 12 months, the patient remained asymptomatic.
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C. U. Onyike, J. O. Bonner, C. G. Lyketsos, and G. J. Treisman
Mania During Treatment of Chronic Hepatitis C With Pegylated Interferon and Ribavirin
Am J Psychiatry,
March 1, 2004;
161(3):
429 - 435.
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