Management of Psychiatric Disorders in a Resident-Run Multi-Disciplinary Clinic Improves Adherence to Interferon Alpha Therapy in Patients with Chronic Hepatitis C

Abstract

Purpose: Treatment of chronic hepatitis C (HCV) in patients with psychiatric illness is controversial secondary to depression and other neuropsychiatric side effects. The purpose of this study is to evaluate adherence to therapy with interferon-alpha in patients with chronic hepatitis C and established psychiatric diagnoses in a resident-run multidisciplinary HCV clinic. Methods: Medicine residents in the HCV clinic are precepted by an attending gastroenterologist and psychiatrist and are supported by a registered nurse coordinator. Treatment for HCV with peg-interferon alpha 2a and ribavirin is guided by evidence-based protocols within the confines of managed care formularies. Baseline psychiatric diagnoses and course of psychiatric illness is followed. Results: 16 patients had baseline psychiatric diagnoses. 7 had Major Depressive Disorder, 3 had Bipolar Disorder, 1 had Generalized Anxiety Disorder, 2 had Schizophrenia and 3 had Schizoaffective Disorder. 10 had co-morbid substance abuse disorders. 1 patient had a substance abuse disorder as the only diagnosis. Throughout treatment with interferon-alpha, all patients were maintained on their psychiatric medications, with rare adjustments. 2 patients needed increases in antidepressant dosage, 1 patient needed an antidepressant added to their regimen, and 13 had no changes in their antidepressant dose. No patient had a significant change in their mood stabilizing/antipsychotic doses. 3 patients had an increase while 13 had no change in dose of their anti-anxiety medication. 1 patient had a psychiatric hospitalization due to bizarre behavior after taking narcotics and benzodiazepines, but interferon treatment was not discontinued. No patients experienced suicidal ideation. None of the 16 patients had interferon therapy discontinued. Conclusions: During treatment of under-insured and uninsured patients with HCV via a resident-initiated, multidisciplinary clinic, there were no significant changes in psychiatric symptoms of the 16 patients with prior psychiatric diagnosis who underwent treatment with interferon-alpha. Strict follow-up, with availability of a gastroenterologist, psychiatrist, residents and a nurse, led to 100% adherence to HCV therapy in psychiatric patients in our HCV clinic. This suggests that an integrative clinic can safely manage psychiatric co-morbidities and interferon-alpha treatment to expand access to care.