Schizophrenic psychosis: A contraindication for treatment of hepatitis C with interferon alpha?

Depressive or psychotic symptoms are a well known side-effect of interferon alpha (INF-alpha). Therefore, the questions arises whether a chronic psych osis should be considered a contraindication for the treatment of active he patitis C with INF-alpha. We report on a 38-year-old woman with a chronic s chizophrenic psychosis, who acquired chronic aggressive hepatitis C. Consid ering the young age of the woman, the potential risk of developing a hepato cellular carcinoma and the result of the liver biopsy, treatment with inter feron alpha 2b (3 x 5 million IU/week) was started. The patient was seen th ree times a week, her psychiatric condition was monitored using the positiv e and negative symptoms score (PANSS). No signs of psychotic or depressive symptoms appeared during INF-alpha therapy. During the first 6 months the l iver enzymes dropped slowly but the virus load was increasing. After adding ribavirin to the therapy, the liver enzymes dropped again, and the PCR car ried out 9 months after initiation and 6 months after the end of the 12 mon ths INF-alpha treatment did not detect any virus RNA. This positive result should encourage prospective studies including patients with these two diag noses on whether patients benefit from INF-alpha.