Cengiz AÇIKEL, Özge ERGÜN, Bahattin ÇELİKÖZ, Servet EBRİNÇ

Suicide attempt of a patient receiving interferon alpha therapy for chronic myeloid leukemia

Kronik myeloid lösemi nedeni ile alfa-interferon tedavisi sürdürülürken mafor depresif bozukluk tanısı ile antidepresif tedavi önerilen ve iki ay sonra intihar girişimi sonucu yüzünden düşük hızlı ateşli silah yaralanması (ASY) geçiren 38 yasında bir erkek hasta sunulmaktadır. Çok parçalı mandibula frakturü iliak kemik grefti ile onarılmıştır. İntihar girişimi sonrası psikiyatrik tedaviye antipsikotik, anksiyolitik ilaçlar eklenmiş, antidepresif ilacın dozu yükseltilmiştir. Hasta bu tedaviye iyi cevap vermiştir. Meslektaşlarımız interferonun olası psikiyatrik yan etkilerinden haberdar olmalı ve bu tür hastalarda rekonstrüksiyon yanında psikiyatrik ve tibbi tedaviyi de gözönünde bulundurmalıdır.

Kronik myeloid lösemi nedeniyle alfa interferon tedavisi gören bir hastanın intihar girişimi

This is a presentation of a 38-year-old male patient who had a low-velocity gunshot wound because: of a suicide attempt. The suicide -attempt occurred after two months of antidepressive drug therapy for a Major Depressive Disorder episode that emerged during alpha-interferon therapy because of his-chronic myeloid leukemia illness. A comminuted mandibular body fracture was reconstructed by iliac bone graft. Antipsychotic and anxiolytic drug therapies were added, and the dose of the antidepressant drug was increased after the suicide attempt. Symptoms deceased after this medical treatment protocol. Our colleagues should be aware of the possible psychiatric side effects of interferon and the consider psychiatric and medical management of such patients, as well as reconstruction..

PDF

___

1. Frierson RL, Lippmann SB. Psychiatric consultation for patients with self-inflicted gunshot wounds. Psychosomatics 1990; 31: 67-74.
2. Siberchicot F, Pinsolle J, Majoufre C, Ballanger A, Gomez D, Caix P. Gunshot injuries of the face. Analysis of 165 cases and réévaluation of the primary treatment. Ann Chir Plast Esthet 1998; 43: 132-140.
3. Schmitz B. Psychiatric syndromes related to antiepileptic drugs. Epilepsia 1999; 40 Suppl 10: 65-70.
4. Wada K, Yamada N, Sato T, Suzuki H, Miki M, Lee Y, Akiyama K, Kuroda S. Corticosteroid-induced psychotic and mood disorders: diagnosis defined by DSM-IV and clinical pictures. Psychosomatics 2001; 42: 461-466.
5. Debien C, De Chouly De Lenclave MB, Foutrein P, Bailly D. Alpha-interferon and mental disorders. Encephale 2001; 27: 308-317.
6. Fattovich G, Giustina G, Favarato S, Ruol A. A survey of adverse events in 11,241 patients with chronic viral hepatitis treated with alfa interferon. J Hepatol. 1996; 24: 38-47.
7. Fukunishi K, Tanaka H, Maruyama J, Takahashi H, Kitagishi H, Ueshima T, Maruyama K, Sakata I. Burns in a suicide attempt related to psychiatric side effects of interferon. Bums 1998; 24: 581-583.
8. Heeringa M, Honkoop P, de Man RA, Feenstra J, Smits CM. Major psychiatric side effects of interferon alpha-2b. Ned Tijdschr Geneeskd 1998; 142: 1618-1621.
9. Janssen HL, Brouwer JT, van der Mast RC, Schalm SW. Suicide associated with alpha- interferon therapy for chronic viral hepatitis. J Hepatol. 1994; 21: 241-243.
10. Renault PF, Haafnagle JH, Park Y. Psychiatric complications of long-term interferon alpha therapy. Arch Intern Med 1987; 147: 1577-1580
11. Schafer M, Messer T, Wegner U, Schmid-Wendtner MH, Volkenandt M. Psychiatric side effects during adjuvant therapy with interferon-alpha in patients with malignant melanoma. Clinical evaluation as well as diagnostic and therapeutic possibilities. Hautarzt 1999; 50: 654-658.
12. Tagaki S. Psychiatric manifestations of interferon therapy. Seishin Igaku 1995; 37: 344-358.
13. Licinio J, Kling MA, Hauser P. Cytokines and brain function: relevance to interferon alpha-induced mood and cognitive changes. Semin Oncol. 1998; 25: 30-38.
14. Meyers CA, Valentine AD: Neurological and psychiatric adverse effects of immunological therapy. CNS Drugs 1995; 3: 56-68.
15. Okereke OI. Neuropsychiatric complications associated with interferon-alpha-2b treatment of malignant melanoma.Psychosomatics. 2002; 43: 237-240.
16. Valentine AD, Meyers CA, Kling MA, Richelson E, Hauser P. Mood and cognitive side effects of interferon- alpha therapy. Semin Oncol 1998; 25(Suppl 1): 39-47.
17. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994.
18. Smedley H, Katrac M, Sikora K. Neurological effects of recombinant human interferon. Br Med J 1983; 286: 262- 264.
19. Rohatiner AZS, Prior PF, Burton AC. Central nervous system toxicity of interferon. Br J Cancer 1983; 47: 419- 422.
20. lino S. Unfavorite effects of interferon in patients with chronic hepatitis C. J Clin Exp Med 1994; 171: 1017- 1022.
21. Mulder RT, Ang M, Chapman B. Interferon treatment is not associated with a worsening of psychiatric symptoms in patients with hepatitis C. J Gastroenterol Hepatol 2000; 15: 300-303.
22. O'Connor NT. Interferon beta and suicide in multiple sclerosis. Lancet 1996; 347: 1417-1418.
23. Wright IA. Monitoring depression in patients undergoing alpha-interferon and ribavirin therapy for hepatitis C. Gastroenterol Nurs 2000; 23: 275-280.
24. Koseki K, Nakano M, Takaiwa M. Suicidal attempts in three postoperative patients with renal cancer after alpha interferon withdrawal. Nippon Hinyokika Gakkai Zasshi 2000; 91: 29-32.
25. Cohen MH, Williams G, Johnson JR. Approval summary for imatinib mesylate capsules in the treatment of chronic myelogenous leukemia. Clin Cancer Res 2002; 8: 935- 942.