Psychosis in a methadone-substituted patient during interferon-alpha treatment of hepatitis C

Interferon-alpha (IFN-alpha is the only effective treatment for chronic hep atitis B and C. Over 2/3 of methadone-substituted patients suffer from chro nic hepatitis C but a history of psychiatric disorders or drug addiction is still seen as a contraindication for IFN-c( because of a possible increase d risk of severe psychiatric side Effects such as depression, suicide attem pts or psychotic episodes. We report on the case of a 33-year-old patient w ith chronic hepatitis C and a positive psychiatric history (drug abuse, bor derline personality and four suicide attempts). After 4 months of therapy w ith IFN-a he developed a psychosis with persecution mania, complex thought disorder, disturbance of sexual identity, sleeplessness, anxiety, depressio n and increased irritability, with suicidal thoughts. Symptoms did not disa ppear after discontinuation of interferon treatment. To our knowledge, ther e are no other reports of persistent psychosis with a possible association to interferon treatment. Development of psychosis and other psychiatric sid e-effects may be an indication of possible neuromodulatory effects of IFN-a lpha with long-term treatment. On the other hand, the treatment for hepatit is C was successful Ideas for safer treatment ill methadone patients with p sychiatric co-morbidity and chronic hepatitis C are needed.