Journal of the Academy of Psychosomatic Medicine
Collaborative Care Psychiatrists Should Play An Active Role in the Hepatitis C Epidemic
BETHESDA, Md., March 13, 2017 /PRNewswire-iReach/ -- The mental health community is well positioned to take a more active role in Hepatitis C virus (HCV) treatment, and Psychosomatic Medicine physicians should assume a collaborative role in caring for psychiatric patients with HCV infection, according to an article published in Psychosomatics, the Journal of the Academy of Psychosomatic Medicine. "Hepatitis C Treatment: Clinical Issues for Psychiatrists in the Post-interferon Era," notes that HCV infection is a widespread and costly cause of morbidity and mortality in the United States (affecting 3.5 million people, roughly 1% of the population), and globally (affecting some 150 to 200 million persons worldwide, roughly 3% of the world population).
About 65% of people infected with HCV in the United States contracted the virus by sharing needles. Other groups at risk include those who have received blood transfusions or transplanted organs before 1992, have had sexual contact with someone with HCV infection, are on hemodialysis, are infected with HIV, are born to mothers with HCV, or work in a health care setting where accidental exposures may occur.
"Research further shows that there is a significant overlap between HCV infection and mental illness," says Yvonne Marie Chasser, M.D., Massachusetts General Hospital, Boston, and lead author of the article. HCV infection occurs at rates 10 to 20 times higher among incarcerated individuals and the severely mentally ill and is also commonly found in those who present for treatment in emergency settings, where there is a high prevalence of mental illness. One study showed that among HCV-infected patients in a hospital liver clinic setting, the rates of mental illness are significantly higher than in the general population, with schizophrenia occurring at 3.9%, bipolar depression at 2.6%, and unipolar depression at 25%.
The authors advise psychiatrists to become more familiar with HCV treatment options, particularly the new oral direct-acting antiviral regimens, which are well-tolerated and more effective than their predecessors. "Psychiatrists should be aware of the potential drug interactions among psychotropic medications and a patient's prescribed direct-acting antiviral medication," said Dr. Chasser. An online resource is provided by the University of Liverpool at www.hep-druginteractions.org.
As with any disease, the sooner treatment is initiated, the better the outcomes. However, despite the emergence of better medications, many patients face barriers due to the high cost of the drugs and the limited eligibility for treatment allowed by insurance companies. In addition, patients with severe mental illness are less likely to have access to HCV screening, diagnostic confirmation, and referral to treatment. "Because multiple barriers exist at every stage of HCV treatment, a portion of patients is lost to follow-up at each step in care," says Dr. Chasser. This phenomenon has been described in other epidemics as the treatment cascade, named for its graphical appearance of a down-going slope representing decreasing percentages of patients remaining in treatment and achieving the desired outcome.
"Because the management of interferon-induced neuropsychiatric side effects is no longer relevant due to new medications now available, psychiatrists should adopt a more proactive role, reflective of the fact that psychiatric populations carry a higher burden of HCV," suggests Dr. Chasser. Building trust is vital to the process of navigating multiple co-morbidities together.
"By optimizing a patient's mental health and reducing barriers to care, psychiatrists can improve a patient's chances of successful HCV treatment. Over time, psychiatrists will build a record of successful outcomes that will facilitate ongoing collaboration between providers and exemplify the transformative effect of integrated care," concludes the article.
The Academy of Psychosomatic Medicine, a professional society of more than 1,200 leading physicians, represents psychiatrists dedicated to the advancement of medical science, education, and health care for persons with co-morbid psychiatric and general medical conditions.
About 65% of people infected with HCV in the United States contracted the virus by sharing needles. Other groups at risk include those who have received blood transfusions or transplanted organs before 1992, have had sexual contact with someone with HCV infection, are on hemodialysis, are infected with HIV, are born to mothers with HCV, or work in a health care setting where accidental exposures may occur.
"Research further shows that there is a significant overlap between HCV infection and mental illness," says Yvonne Marie Chasser, M.D., Massachusetts General Hospital, Boston, and lead author of the article. HCV infection occurs at rates 10 to 20 times higher among incarcerated individuals and the severely mentally ill and is also commonly found in those who present for treatment in emergency settings, where there is a high prevalence of mental illness. One study showed that among HCV-infected patients in a hospital liver clinic setting, the rates of mental illness are significantly higher than in the general population, with schizophrenia occurring at 3.9%, bipolar depression at 2.6%, and unipolar depression at 25%.
The authors advise psychiatrists to become more familiar with HCV treatment options, particularly the new oral direct-acting antiviral regimens, which are well-tolerated and more effective than their predecessors. "Psychiatrists should be aware of the potential drug interactions among psychotropic medications and a patient's prescribed direct-acting antiviral medication," said Dr. Chasser. An online resource is provided by the University of Liverpool at www.hep-druginteractions.org.
As with any disease, the sooner treatment is initiated, the better the outcomes. However, despite the emergence of better medications, many patients face barriers due to the high cost of the drugs and the limited eligibility for treatment allowed by insurance companies. In addition, patients with severe mental illness are less likely to have access to HCV screening, diagnostic confirmation, and referral to treatment. "Because multiple barriers exist at every stage of HCV treatment, a portion of patients is lost to follow-up at each step in care," says Dr. Chasser. This phenomenon has been described in other epidemics as the treatment cascade, named for its graphical appearance of a down-going slope representing decreasing percentages of patients remaining in treatment and achieving the desired outcome.
"Because the management of interferon-induced neuropsychiatric side effects is no longer relevant due to new medications now available, psychiatrists should adopt a more proactive role, reflective of the fact that psychiatric populations carry a higher burden of HCV," suggests Dr. Chasser. Building trust is vital to the process of navigating multiple co-morbidities together.
"By optimizing a patient's mental health and reducing barriers to care, psychiatrists can improve a patient's chances of successful HCV treatment. Over time, psychiatrists will build a record of successful outcomes that will facilitate ongoing collaboration between providers and exemplify the transformative effect of integrated care," concludes the article.
The Academy of Psychosomatic Medicine, a professional society of more than 1,200 leading physicians, represents psychiatrists dedicated to the advancement of medical science, education, and health care for persons with co-morbid psychiatric and general medical conditions.
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