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Psychosis Associated with Interferon Alfa Therapy for Chronic Hepatitis B

Assistant Professor, Department of Psychiatry, Faculty of Medicine, Cukurova University, Adana, Turkey

Deniz Yerdelen, MD

Resident, Department of Neurology, Faculty of Medicine, Cukurova University

Nurgul Ozpoyraz, MD

Professor, Department of Psychiatry, Faculty of Medicine, Cukurova University

Reprints: Lut Tamam MD, Cukurova University, Tip Fakultesi, Psiki-yatri Anabilim Dali, 01330 Balcali, Adana, Turkey, FAX 90-322-3386505, E-mail Ltamam{at}mail.cu.edu.tr, Ltamam{at}yahoo.com

OBJECTIVE: To report a case of persistent psychosis that developed during interferon alfa (IFN-) therapy for chronic hepatitis B.

CASE SUMMARY: A 26-year-old man who was diagnosed with active chronic hepatitis B began treatment with IFN-. Five months after initiation of therapy, he developed acute psychosis with prominent persecutory delusions and auditory hallucinations. Despite discontinuation of IFN- therapy and addition of antipsychotic drug treatment, only partial recovery from psychosis was observed after 4 months of hospitalization.

DISCUSSION: Unlike many previously reported cases, this patient showed only partial recovery from psychosis, despite the discontinuation of IFN therapy. Except for receiving a relatively high dose of IFN- (10 million units 3 times/wk), the patient did not have any previously proposed risk factors for developing psychiatric adverse effects. The Naranjo probability scale indicates a probable relationship between the acute psychosis and IFN therapy.

CONCLUSIONS: Despite its rare occurrence, psychosis can emerge during IFN- therapy. This adverse effect may persist for several months, even after appropriate medical management. IFN- should be used with careful monitoring of patients' psychiatric status during all stages of therapy.

Key Words: chronic hepatitis B, interferon alfa, psychosis

Published Online, January 13, 2003. www.theannals.com, DOI 10.1345/aph.1C266

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