Reviewer ’s report  
 
Title: A case report of psychiatric symptoms following direct -acting antiviral and ribavirin 
combination therapy for chronic hepatitis C in a patient with innate anxiety  
 
Version: 1 Date: 21 Mar 2019  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
No - there are minor issues  
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
N/A - no methodology  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
N/A - no experiments or analyses  
 
STATISTICS - Is the use of statistics  in the manuscript appropriate?  
N/A - there are no statistics in this study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
N/A - no results to interpret  
 
OVERALL MANUSCRIPT POTENTIAL - Is the curren t version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Maybe - with major revisions  
 
PEER REVIEWER COMMENTS:  
GENERAL COMMENTS: The authors present a clinical case of a patient who experiences 
somatizat ion syndrome as a psychiatric adverse effect from oral DAA therapy for chronic HCV 
infection.    The authors have nicely framed the clinical importance of this case as justification 
for careful assessment of pre -existing psychiatric disease in all patients  with HCV prior to 
antiviral therapy.  They have additionally provided an effective visual figure for the timeline of 
antiviral therapy with key laboratory values and psychiatric events.  
 
REQUESTED REVISIONS:  
A more complete clinical presentation with ful l detail of the patient's medical history is needed, 
particularly related to her liver disease and other medical history relevant to psychiatric 
presentation .  The authors should provide more details regarding the patient's liver disease - 
what is the sta ge of liver fibrosis/cirrhosis? does the patient have co -infection with HBV or HIV? 
what medications does the patient take? does the patient have alcohol or substance use issues? 
the physical exam should not be limited to a description as unremarkable, but  should provide 
appropriate detail, particularly for positive/negative findings for the liver, neurologic, and 
psychiatric exams.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
Language quality requires significant revision due to grammar and word choice issues 
throughout the manuscript.  Rewriting with a native English writer would significantly 
strengthen the readability of the manuscript.  
Note: This reviewer report can be dow nloaded - see attached pdf file.  
Are the methods appropriate and well described?  
If not, pl ease specify what is required in your comments to the authors.  
 
Unable to assess  
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the da ta shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding , or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the  publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, writ e 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their commen ts online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendati on. 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: A case report of psychiatric symptoms following direct -acting antiviral and ribavirin 
combination therapy for chronic hepatitis C in a patient with innate anxiety  
 
Version: 1 Date: 21 Mar 2019  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
No - there are minor issues  
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
N/A - no methodology  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
N/A - no experiments or analyses  
 
STATISTICS - Is the use of statistics  in the manuscript appropriate?  
N/A - there are no statistics in this study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
N/A - no results to interpret  
 
OVERALL MANUSCRIPT POTENTIAL - Is the curren t version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Maybe - with major revisions  
 
PEER REVIEWER COMMENTS:  
GENERAL COMMENTS: The authors present a clinical case of a patient who experiences 
somatizat ion syndrome as a psychiatric adverse effect from oral DAA therapy for chronic HCV 
infection.    The authors have nicely framed the clinical importance of this case as justification 
for careful assessment of pre -existing psychiatric disease in all patients  with HCV prior to 
antiviral therapy.  They have additionally provided an effective visual figure for the timeline of 
antiviral therapy with key laboratory values and psychiatric events.  
 
REQUESTED REVISIONS:  
A more complete clinical presentation with ful l detail of the patient's medical history is needed, 
particularly related to her liver disease and other medical history relevant to psychiatric 
presentation .  The authors should provide more details regarding the patient's liver disease - 
what is the sta ge of liver fibrosis/cirrhosis? does the patient have co -infection with HBV or HIV? 
what medications does the patient take? does the patient have alcohol or substance use issues? 
the physical exam should not be limited to a description as unremarkable, but  should provide 
appropriate detail, particularly for positive/negative findings for the liver, neurologic, and 
psychiatric exams.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
Language quality requires significant revision due to grammar and word choice issues 
throughout the manuscript.  Rewriting with a native English writer would significantly 
strengthen the readability of the manuscript.  
Note: This reviewer report can be dow nloaded - see attached pdf file.  
Are the methods appropriate and well described?  
If not, pl ease specify what is required in your comments to the authors.  
 
Unable to assess  
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the da ta shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding , or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the  publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, writ e 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their commen ts online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendati on. 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: A case report of psychiatric symptoms following direct -acting antiviral and ribavirin 
combination therapy for chronic hepatitis C in a patient with innate anxiety  
 
Version: 1 Date: 21 Mar 2019  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
No - there are minor issues  
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
N/A - no methodology  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
N/A - no experiments or analyses  
 
STATISTICS - Is the use of statistics  in the manuscript appropriate?  
N/A - there are no statistics in this study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
N/A - no results to interpret  
 
OVERALL MANUSCRIPT POTENTIAL - Is the curren t version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Maybe - with major revisions  
 
PEER REVIEWER COMMENTS:  
GENERAL COMMENTS: The authors present a clinical case of a patient who experiences 
somatizat ion syndrome as a psychiatric adverse effect from oral DAA therapy for chronic HCV 
infection.    The authors have nicely framed the clinical importance of this case as justification 
for careful assessment of pre -existing psychiatric disease in all patients  with HCV prior to 
antiviral therapy.  They have additionally provided an effective visual figure for the timeline of 
antiviral therapy with key laboratory values and psychiatric events.  
 
REQUESTED REVISIONS:  
A more complete clinical presentation with ful l detail of the patient's medical history is needed, 
particularly related to her liver disease and other medical history relevant to psychiatric 
presentation .  The authors should provide more details regarding the patient's liver disease - 
what is the sta ge of liver fibrosis/cirrhosis? does the patient have co -infection with HBV or HIV? 
what medications does the patient take? does the patient have alcohol or substance use issues? 
the physical exam should not be limited to a description as unremarkable, but  should provide 
appropriate detail, particularly for positive/negative findings for the liver, neurologic, and 
psychiatric exams.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
Language quality requires significant revision due to grammar and word choice issues 
throughout the manuscript.  Rewriting with a native English writer would significantly 
strengthen the readability of the manuscript.  
Note: This reviewer report can be dow nloaded - see attached pdf file.  
Are the methods appropriate and well described?  
If not, pl ease specify what is required in your comments to the authors.  
 
Unable to assess  
 
  
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the da ta shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript : 
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding , or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the  publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, writ e 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their commen ts online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendati on. 
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Acc ess Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant