Interferon-Induced Psychosis as a “Psychiatric Contraindication” to Hepatitis C Treatment: A Review and Case-Based Discussion

BackgroundHepatitis C (HCV) infection is a major cause of liver disease, cirrhosis, and hepatocellular carcinoma. Interferon-based treatments have the potential to decrease the burden of disease, but are complicated by side effects, including neuropsychiatric symptoms.ObjectiveThe authors described a case of interferon-induced psychosis as a framework to review the literature and discuss the decision to pursue antiviral treatment in psychiatrically ill patients with hepatitis C.MethodThe authors followed a patient with chronic HCV who received interferon and ribavirin and who developed hallucinations ultimately requiring psychiatric hospitalization.ResultsDespite treatment with various neuroleptics, the psychosis resolved only when the interferon/ribavirin were discontinued.ConclusionPsychiatric illness should not rule out the possibility of interferon-based therapy, but it calls for close integration of psychiatric and medical care and individualized decision-making based on the biological and psychosocial circumstances of each case.