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.

Schlüsselwörter

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

Key words

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

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