Hepatitis C bei Patienten mit psychiatrischen Erkrankungen

Zusammenfassung

Patienten mit psychischen Erkrankungen haben ein erhöhtes Risiko mit dem Hepatitis C-Virus infiziert zu sein. Trotz aktueller medikamentöser Entwicklungen besteht die Standardbehandlung der chronischen Hepatitis C derzeit noch aus einer Kombination von pegyliertem Interferon-alpha (IFN-α) und Ribavirin. Die Therapie der Patienten mit dem Zytokin IFN-α ist mit zahlreichen psychiatrischen Nebenwirkungen verbunden. Aus diesem Grunde werden Patienten mit psychiatrischen Vorerkrankungen immer noch häufig von einer Therapie der chronischen Hepatitis C ausgeschlossen. Die aktuelle Arbeit gibt eine Übersicht über Studien, die sich mit der Häufigkeit und Behandlung der chronischen Hepatitis C bei Patienten mit psychiatrischen Störungen beschäftigen. Prospektive kontrollierte Daten weisen auf eine gleich gute Behandelbarkeit von Patienten mit psychischen Störungen gegenüber Kontrollgruppen hin. Dieses trifft für Patienten mit vorbekannten Depressionen ebenso wie für Patienten mit Störungen aus dem schizophrenen Formenkreis zu. Patienten mit psychiatrischen Erkrankungen müssen daher nicht von einer antiviralen Therapie ausgeschlossen werden. Aufgrund der möglichen Komplikationen während der Therapie sollte aber eine Behandlung dieser Patienten in einem interdisziplinären Netzwerk mit engmaschiger Betreuung erfolgen.

Abstract

Patients with psychiatric disorders have an increased risk to be infected with the hepatitis C virus. Combination treatment with Interferon-alpha (IFN-α) and Ribavirin is still the standard for antiviral therapy of chronic HCV-Infection. Especially the treatment with IFN-α is associated with several mild to severe psychiatric side effects. As a consequence, most patients with psychiatric comorbidity are still excluded from antiviral treatment. The review summarizes currently available data about prevalence and treatment of chronic hepatitis C infection in patients with psychiatric disorders. Prospective controlled trials have been published, indicating, that HCV-infected patients with psychiatric disorders have a similar treatment response, adherence and a similar risk to discontinue treatment early if compared to controls without a psychiatric comorbidity. This has been shown not only for patients with depression or anxiety disorder, but also for patients with schizophrenia. Patients with psychiatric comorbidity do not have to be excluded from antiviral treatment with IFN-α. However, because of possible complications, patients should be treated in centres with a close interdisciplinary cooperation.

Hepatitis C - Interferon-alpha - Depression - Schizophrenie - Response - psychische Erkrankung

Hepatitis C - Interferon-alpha - depression - schizophrenia - psychiatric disorders - response

Literatur

• 1 Chang TT, Lin H, Yen YS. et al . Hepatitis B and hepatitis C among institutionalized psychiatric patients in Taiwan.  J Med Virol. 1993;  40 170-173
• 2 Dinwiddie SH, Shicker L, Newman T. Prevalence of hepatitis C among psychiatric patients in the public sector.  Am J Psychiatry. 2003;  160 172-174
• 3 Cividini A, Pistorio A, Regazzetti A. et al . Hepatitis C virus infection among institutionalised psychiatric patients: a regression analysis of indicators of risk.  J Hepatol. 1997;  27 455-463
• 4 Rosenberg SD, Goodman LA, Osher FC. et al . Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness.  Am J Public Health. 2001;  91 31-37
• 5 Meyer JM. Prevalence of hepatitis A, hepatitis B, and HIV among hepatitis C-seropositive state hospital patients: results from Oregon State Hospital.  J Clin Psychiatry. 2003;  64 540-545
• 6 Huppe D, Zehnter E, Mauss S. et al . Epidemiology of chronic hepatitis C in Germany – an analysis of 10 326 patients in hepatitis centres and outpatient units.  Z Gastroenterol. 2008;  46 34-44
• 7 Batista-Neves SC, Quarantini LC, de Almeida AG. et al . High frequency of unrecognized mental disorders in HCV-infected patients.  Gen Hosp Psychiatry. 2008;  30 80-82
• 8 Schaefer M, Heinz A, Backmund M. Treatment of chronic hepatitis C in patients with drug dependence: time to change the rules?.  Addiction. 2004;  99 1167-1175
• 9 Butt AA, Wagener M, Shakil AO. et al . Reasons for non-treatment of hepatitis C in veterans in care.  J Viral Hepat. 2005;  12 81-85
• 10 Pariante CM, Landau S, Carpiniello B. Interferon alfa-induced adverse effects in patients with a psychiatric diagnosis.  N Engl J Med. 2002;  347 148-149
• 11 Pariante CM, Orru MG, Baita A. et al . Treatment with interferon-alpha in patients with chronic hepatitis and mood or anxiety disorders.  Lancet. 1999;  354 131-132
• 12 Van Thiel DH, Friedlander L, Molloy PJ. et al . Interferon-alpha can be used successfully in patients with hepatitis C virus-positive chronic hepatitis who have a psychiatric illness.  Eur J Gastroenterol Hepatol. 1995;  7 165-168
• 13 Van Thiel DH, Anantharaju A, Creech S. Response to treatment of hepatitis C in individuals with a recent history of intravenous drug abuse.  Am J Gastroenterol. 2003;  98 2281-2288
• 14 Schaefer M, Schmidt F, Folwaczny C. et al . Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups.  Hepatology. 2003;  37 443-451
• 15 Schaefer M, Hinzpeter A, Mohmand A. et al . Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin: Response and psychiatric side effects.  Hepatology. 2007;  46 991-998
• 16 Huckans M, Mitchell A, Ruimy S. et al . Antiviral Therapy Completion and Response Rates Among Hepatitis C Patients With and Without Schizophrenia.  Schizophr Bull. 2008 [Epub]; 
• 17 Loftis JM, Matthews AM, Hauser P. Psychiatric and substance use disorders in individuals with hepatitis C: epidemiology and management.  Drugs. 2006;  66 155-174
• 18 Schaefer M, Mauss S. Hepatitis C Treatment in Patients with Drug Addiction: Clinical Management of Interferon-Alpha-Associated Psychiatric Side Effects.  Current Drug Abuse Reviews. 2008;  1 177-187
• 19 Schafer M, Schmidt F, Grunze H. et al . Interferon alpha-associated agranulocytosis during clozapine treatment. Case report and status of current knowledge.  Nervenarzt. 2001;  72 872-875
• 20 Gohier B, Goeb JL, Rannou-Dubas K. et al . Hepatitis C, alpha interferon, anxiety and depression disorders: a prospective study of 71 patients.  World J Biol Psychiatry. 2003;  4 115-118
• 21 Schäfer M. Hepatitis-C-Therapie: Management psychiatrischer Nebenwirkungen von Interferon alfa. Stuttgart, New York: Georg Thieme Verlag 2004
• 22 Schäfer M. Hepatitis-C-Therapie: Management psychiatrischer Risikogruppen und Behandlung psychiatrischer Nebenwirkungen von Interferon alfa. 2 ed. Georg Thieme Verlag, Stuttgart 2006
• 23 Gleason OC, Yates WR, Isbell MD. et al . An open-label trial of citalopram for major depression in patients with hepatitis C.  J Clin Psychiatry. 2002;  63 194-198
• 24 Gleason OC, Yates WR, Philipsen MA. Major depressive disorder in hepatitis C: an open-label trial of escitalopram.  Prim Care Companion J Clin Psychiatry. 2005;  7 225-230
• 25 Hauser P, Khosla J, Aurora H. et al . A prospective study of the incidence and open-label treatment of interferon-induced major depressive disorder in patients with hepatitis C.  Mol Psychiatry. 2002;  7 942-947
• 26 Kraus MR, Schafer A, Faller H. et al . Paroxetine for the treatment of interferon-alpha-induced depression in chronic hepatitis C.  Aliment Pharmacol Ther. 2002;  16 1091-1099
• 27 Levenson JL, Fallon HJ. Fluoxetine treatment of depression caused by interferon-alpha.  Am J Gastroenterol. 1993;  88 760-761
• 28 Schafer M, Schmidt F, Amann B. et al . Adding low-dose antidepressants to interferon alpha treatment for chronic hepatitis C improved psychiatric tolerability in a patient with schizoaffective psychosis.  Neuropsychobiology. 2000;  42 ((Suppl 1)) 43-45
• 29 Schramm TM, Lawford BR, Macdonald GA. et al . Sertraline treatment of interferon-alfa-induced depressive disorder.  Med J Aust. 2000;  173 359-361
• 30 Valentine AD, Meyers CA. Successful treatment of interferon-alpha-induced mood disorder with nortriptyline.  Psychosomatics. 1995;  36 418-419
• 31 Schaefer M, Schwaiger M, Garkisch AS. et al . Prevention of interferon-alpha associated depression in psychiatric risk patients with chronic hepatitis C.  J Hepatol. 2005;  42 793-798
• 32 Kraus MR, Schafer A, Schöttker K. et al . Therapy of interferon-induced depression in chronic hepatitis C with citalopram: A randomized, double-blind, placebo-controlled study.  Gut. 2007;  57 531-536
• 33 Gleason OC, Fucci JC, Yates WR. et al . Preventing Relapse of Major Depression During Interferon-alpha Therapy for Hepatitis C-A Pilot Study.  Dig Dis Sci. 2007;  52 2557-2563
• 34 Kraus MR, Schafer A, Al Taie O. et al . Prophylactic SSRI during interferon alpha re-therapy in patients with chronic hepatitis C and a history of interferon-induced depression.  J Viral Hepat. 2005;  12 96-100
• 35 Raison CL, Woolwine BJ, Demetrashvili MF. et al . Paroxetine for prevention of depressive symptoms induced by interferon-alpha and ribavirin for hepatitis C.  Aliment Pharmacol Ther. 2007;  25 1163-1174
• 36 Maddock C, Baita A, Orru MG. et al . Psychopharmacological treatment of depression, anxiety, irritability and insomnia in patients receiving interferon-alpha: a prospective case series and a discussion of biological mechanisms.  J Psychopharmacol. 2004;  18 41-46
• 37 Schaefer M. Clinical management of interferon-alfa-associated psychiatric side effects during hepatitis C treatment.  Hot Topics in Viral Hepatitis. 2008;  9 11-20
• 38 Matthew AM, Huckans MS, Blackwell AD. et al . Hepatitis C testing and infection rates in bipolar patients with and without comorbid substance use disorders.  Bipolar Disord. 2008;  10 266-270
• 39 Freudenreich O, Gandhi RT, Walsh JP. et al . Hepatitis C in schizophrenia: screening experience in a community-dwelling clozapine cohort.  Psychosomatics. 2007;  45 405-411

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