Editorial Credits/ Crédits éditorials

Subscription Rates /Prix d'abonnements

Advertising Rates / Tarifs publicitaires (PDF)

Guest Editorial
Highlighting Bipolar II Disorder
Gordon Parker, MD, PhD, DSc, FRANZCP
(PDF)

In Review
Neurobiological Findings in Bipolar II Disorder Compared With Findings in Bipolar I Disorder
Brent M McGrath, BSc, MSc, Phillip H Wessels, MD, FRCPC, Emily C Bell, BSc, MSc, Michele Ulrich, BSc, Peter H Silverstone, MB, BS, MD, MRCPsych, FRCPC
(PDF)

Bipolar II Disorder: An Overview of Recent Developments
George Hadjipavlou, MA, MD, Hiram Mok, MA, MB, BCh, BAO, FRCPC, Lakshmi N Yatham, MBBS, MRCPsych, FRCPC3 (PDF)

Review Paper
Bipolar Disorder: It’s All in Your Mind? The Neuropsychological Profile of a Biological Disorder
Gin S Malhi, BSc, MB, ChB, MRCPsych, FRANZCP, Belinda Ivanovski, Ssc Psychol, M Clin Psychol, Viktoria Szekeres, BSc,Psychol
(PDF)

Original Research
Impact of Culture on Depressive Symptoms of Elderly Chinese Immigrants
Glenda MacQueen, MD, PhD, FRCPC
Daniel WL Lai, PhD
(PDF)

Development and Reliability of a Pictorial Mental Disorders Screen for Young Adolescents
Nicole Smolla, PhD, Jean-Pierre Valla, MD, MSc, Lise Bergeron, PhD, Claude Berthiaume, MSc, Marie St-Georges, MPs
(PDF)

Command Hallucinations Among Asian Patients With Schizophrenia
Theresa MY Lee, MBBS, MMed, Siow Ann Chong, MBBS, MMed, Yiong Huat Chan, PhD, Gangaharan Sathyadevan, MBBS, MRCPsych
(PDF)

The Centre for Addiction and Mental Health Concurrent Disorders Screener
Juan C Negrete, MD, FRCPC, Jane Collins, MSc, Nigel E Turner, PhD, Wayne Skinner, MSW
(PDF)

Validation de la version française du questionnaire de Sociotropie-Autonomie de Beck et collègues
Mathilde M Husky, MSc, Olivier S Grondin, MSc, Philippe D Compagnone, PhD
(PDF)

Brief Communication
Depressive Symptoms and Alcohol Consumption Among Nonalcoholic Depression Patients Treated With Desipramine
Benjamin I Goldstein, MD, PhD, Ayal Schaffer, MD, FRCPC, Anthony Levitt, MD, FRCPC, Ari Zaretsky, MD, FRCPC, Russell T Joffe, MD, FRCPC, Virginia Wesson, MD, R Michael Bagby, PhD
Pierre Bleau, MD, FRCPC
(PDF)

Letters to the Editor
(PDF)

Safety of Clozapine in 2 Successive Pregnancies

Revisiting the Diagnostic Challenges of Secondary Mania and Bipolar Disorder in a Patient With Borderline Hyperthyroidism

Dyslipidaemia and Psychiatric Patients

Dream Contents in Patients With Major Depressive Disorder

Sensory Deprivation and Disorders of Perception

Re: The Internet’s Impact on the Practice of Psychiatry

Response: The Internet’s Impact on the Practice of Psychiatry

Denial and Avoidance in an Unusual Case of Death From Breast Cancer

Interferon-Induced Mania

Drug-Induced Psychosis After Long-Term Treatment With Levetiracetam

Priapism

An Ounce of Prevention: “COPEing with Toddler Behaviour”

Internet Gaming Addiction

Letters to the Editor

Interferon-Induced Mania

Dear Editor:
Hepatitis C is a chronic viral illness and a leading cause of cirrhosis and liver failure. Treatment of this condition is limited, with pegylated interferon-alpha (IFN-alpha ) and antiviral drugs being the mainstay of treatment. Unfortunately, these drugs may have various side effects and a broad range of neuropsychiatric manifestations. We report on a case that illustrates mania secondary to antiviral agents.

Case Report

Mr A, a white man aged 41 years, was brought to the emergency room (ER) by his girlfriend when she noted that he had not sleeping well and that he had been getting increasingly disorganized over the preceding week. It appears that he had been started on IFN-alpha after a diagnosis of hepatitis C was made by his gastroenterologist. He began to exhibit mood instability and subsequently presented to the ER with a several-day episode of poor sleep, along with delusions of grandiosity, persecution, and reference. His thoughts were disorganized, and he was belligerent. His girlfriend reported that he was more religiously preoccupied than usual. There was no evidence of intent to harm himself or others. He did not have a psychiatric history prior to starting interferon treatment.

Mr A was admitted to hospital and, after consulting with his gastroenterologist, interferon and ribavirin were withheld, and he was stabilized with haloperidol. He showed a remarkably swift recovery over the next few days, after which he was discharged home.

Discussion

Treatment of chronic hepatitis C is difficult and is further complicated by the fact that IFN-alpha is associated with severe neuropsychiatric adverse events in some patients. The presence of preexisting psychiatric diagnosis has not been shown to be a risk indicator (1). Presence of a subclinical neurological condition, however, may place the patient at a higher risk (2). In our patient, the timeline between drug administration and appearance of symptoms strongly implicates the drug as the cause. Since the psychopathophysiology of mania in IFN-alpha treatment is largely speculative, clinical risk stratification remains largely unsatisfactory. Controlled trials are needed to determine optimum treatment options in these complicated patients.

Funding and Support

None of the authors have any financial or professional connection to any product mentioned above.

References

1. Malek-Ahmadi P. Mood disorders associated with interferon treatment: theoretical and practical considerations. Ann Pharmacother 2001;35:489–95.

2. Adams F, Fernandez F, Mavligit G. Interferon-induced organic mental disorders associated with unsuspected pre-existing neurologic abnormalities. J Neurooncol 1988;6:355–9.

Asif R Malik, MD; Saj Ravasia, MD, CCFP, FRCPC, DABPN
Fargo, North Dakota