Introduction: Hepatitis B virus is one of the leading factor of liver paranchyme damage which is important for morbidity and mortality. Interferon treatment is related to many psychiatric side effects like depression, depressive mood, suicidal thoughts, irritability, tiredness, cognitive impairement, mania and psychosis.
Case: A 17-year-old student in high school male patient, He was diagnosed as hepatitis B infection one year ago.After treatment with interferon and lamivudine in 8th week he became depressive and had suicidal thoughts and feeling of guiltiness 2 days before application to our clinic. In his thought content there were having delusions of harm and guiltines, which were compatible with his affect. He had low psychomotor activity, depressive and sometimes dysphoric affect. He had normal physical and norological examination and routine biochemical tests. He had no pathology in cranial MR and EEG. His treatment with interferon and lamivudine was stopped. Citalopram 10 mg/day and risperidone 3mg/day were started. Due to development of incontinans, rigidity, bradykinesia and tremor, risperidone was stopped and biperiden and lorazepam were started. In the first week of his hospitalization signs of Parkinsonism disappeared and 5mg olanzapine was started for the psychotic symptoms. But as a result of development of extrapyramidal signs it was stopped and aripiprazole 5 mg/day was started. In the 3rd week of his hospitalization aripiprazole increased to 10 mg/day and essitalopram 15mg/day was added to treatment. With the treatment he had increased wilingness to conversation and better thought content. But he had nihilistic mystic and harm delusions. He also had şuctuations of affect. In the 4th week of his hospitalization psychotic symptoms significantly decreased and essitalopram dose for the depressive symptoms increased to 20 mg/day. In the 7th week of his hospitalisation he was sent home who had normal liver function tests and healed depression.
Discussion: It was reported that 23.2%-39% of patients had depression in case of interferon usage as a side effect. Depressive symptoms due to interferon alpha is seen generally in 8th week significantly. It is known that interferon affects central nervous system directly. Extrapyramidal side effects were reported in some cases although low doses of antipsychotics were used for the psychosis developed after the use of interferon. In our case although antipsychotic was used in a low dose extrapyramidal side effects related to dopaminergic systems like Parkinsonism was seen. In literature presence of similar cases shows that in the treatment of psychotic symptoms related with interferon use low dose antipsychotics with little dopaminergic effect is important.