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Abstract
The NP's role in managing cirrhosis is increasing due to the growing prevalence of the disease. The purpose of this article is to review the pathophysiology, diagnosis, and management of patients with cirrhosis with an emphasis on interdisciplinary collaboration and evidence-based practice. Cirrhosis complications are also discussed.
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52
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Wang B, Lu S, Zhang C, Zhu L, Li Y, Bai M, Xu E. Quantitative proteomic analysis of the liver reveals antidepressant potential protein targets of Sinisan in a mouse CUMS model of depression. Biomed Pharmacother 2020; 130:110565. [PMID: 32745909 DOI: 10.1016/j.biopha.2020.110565] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/17/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022] Open
Abstract
In traditional Chinese medicine, the role of the liver in depression is highly valued, and liver-relieving drugs, such as Sinisan, are often used to treat depression; however, the mechanism whereby these drugs work remains unclear. The present study aimed to reveal possible antidepressant mechanisms of Sinisan (SNS) by analyzing hepatic proteomics in chronic unpredictable mild stress (CUMS) mice. Using the CUMS mouse model of depression, the antidepressant effects of SNS were assessed by the sucrose preference test (SPT) and forced swimming test (FST). Hepatic differentially expressed proteins (DEPs) after SNS treatment were investigated by tandem mass tag (TMT) based quantitative proteomics analysis. Then, a bioinformatics analysis of DEPs was conducted through hierarchical clustering, Venn analysis, Gene Ontology (GO) annotation enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. DEP genes were further validated by quantitative real-time polymerase chain reaction (qRT-PCR) analysis and western blotting. Behavioral results demonstrated that SNS significantly increased sucrose intake in SPT and shortened the immobility time in FST in model mice. Eighty-two DEPs were identified, including 37 upregulated and 45 downregulated proteins, between model and SNS groups. Enrichment analysis of GO annotations indicated that SNS primarily maintained cellular iron ion homeostasis by iron ion transportation and regulated expression of some extracellular structural proteins for oxidation-reduction processes. KEGG and Venn analysis showed that mineral absorption, steroid hormone biosynthesis and metabolism might be the principal pathways through which SNS acts on depression. Furthermore, several proteins involved in the biosynthesis and metabolism of steroid hormone pathways were significantly up/downregulated by SNS, including CYP2B19, CYP7B1 (validated by qRT-PCR) and HSD3b5 (validated by qRT-PCR and western blotting). Our results indicate that SNS plays important roles in antidepressant actions by restoring DEPs, resulting in the biosynthesis and metabolism of steroid hormones. The current results provide novel perspectives for revealing potential protein targets of SNS in depression.
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Affiliation(s)
- Baoying Wang
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
| | - Shuaifei Lu
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China
| | - Changjing Zhang
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China
| | - Leilei Zhu
- School of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yucheng Li
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Ming Bai
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
| | - Erping Xu
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Academy of Traditional Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
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53
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Tavabie O, McKie P, Webzell I, Beckford R, Menon K, O'Grady J, Aluvihare VR. Anxiety and depression on the liver transplant waiting list: a case for psychological prehabilitation? GASTROINTESTINAL NURSING 2020. [DOI: 10.12968/gasn.2020.18.sup6.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: Anxiety and depression in patients awaiting liver transplantation are associated with worse clinical outcomes. However, optimising patient mental health is not routinely addressed in pre-transplant care. Aims: To understand the prevalence of anxiety and depression in patients awaiting transplantation and their access to pharmacological and psychological therapies. Methods: Patients awaiting transplantation were offered screening for anxiety and depression using the Hospital Anxiety and Depression Screening (HADS) tool. Data pertaining to patient demographics and previous treatment for anxiety and depression were recorded and analysed. Findings: Over 50% of patients recorded abnormal scores for anxiety and depression. Of the 19 patients screened, 42% had received treatment for either disorder, and most found the intervention unhelpful due to lack of follow-up appointments and limited understanding of their underlying chronic liver disease. There was a significant association between female sex and screening positive for depression. Conclusion: Anxiety and depression are prevalent in patients awaiting liver transplantation. The integration of a psychologist into the transplantation multidisciplinary team may improve patient outcomes.
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Affiliation(s)
- Oliver Tavabie
- Clinical Research Fellow; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Paul McKie
- Specialist Social Worker; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Ian Webzell
- Alcohol and Substance Misuse Clinical Nurse Specialist; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Racquel Beckford
- Liver Transplant Co-ordinator; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Krishna Menon
- Consultant Liver Transplant Surgeon and Hepatobiliary Surgeon; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - John O'Grady
- Professor of Hepatology and Liver Transplantation; the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
| | - Varuna R Aluvihare
- Consultant Transplant Hepatologist and Chair of the British Liver Transplant Group, the Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
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54
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Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol 2020; 46-47:101684. [PMID: 33158471 DOI: 10.1016/j.bpg.2020.101684] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) enables rapid transition from critical illness and poor prognosis back to health. After LT, health-related quality of life (HRQoL) generally becomes comparable to that of the general population, although some deficits in mainly physical domains are frequent. However, recipients continue to have symptoms related to immunosuppression, complications, and other things, which impact HRQoL and the recipient's ability to regain independence and re-establish function in everyday life. Less than half of LT recipients return to work. Reportedly, HRQoL seems to deteriorate slightly over the long-term, but still remains satisfactory. Physical fatigue is common, but recent studies show that structured exercise programs improve both fatigue and HRQoL. Emerging evidence also suggests that continued patient information, structured psychosocial support systems, and caregiver involvement might further help improve long-term HRQoL. More research is needed to gain better understanding of the factors affecting long-term HRQoL, and how to best improve HRQoL.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland; The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
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55
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Chen C, Yin Q, Tian J, Gao X, Qin X, Du G, Zhou Y. Studies on the potential link between antidepressant effect of Xiaoyao San and its pharmacological activity of hepatoprotection based on multi-platform metabolomics. JOURNAL OF ETHNOPHARMACOLOGY 2020; 249:112432. [PMID: 31790818 DOI: 10.1016/j.jep.2019.112432] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 05/22/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In traditional Chinese medicine (TCM) theory, depression is considered to be "liver qi stagnation", and relieving "liver qi stagnation" is regarded as an effective method for treating depression. Xiaoyao San (XYS) is a well-known TCM formula for the treatment of depression by relieving "liver qi stagnation". This formula consists of Radix Paeoniae Alba (Paeonia lactiflora Pall.), Radix Bupleuri (Bupleurum chinense DC.), Poria (Poria cocos (Schw.) Wolf), Rhizoma Atractylodis Macrocephalae (Atractylodes macrocephala Koidz.), Radix Angelicae Sinensis (Angelica sinensis (Oliv.) Diels), Radix Glycyrrhizae (Glycyrrhiza uralensis Fisch.), Rhizoma Zingiberis Recens (Zingiber officinale Roscoe) and Herba Menthae Haplocalycis (Mentha haplocalyx Briq.). AIM OF THE STUDY Several studies have suggested that depression is associated with liver injury. XYS was a well-known TCM formula for the treatment of depression and liver stagnancy. However, it was still unknown whether the antidepressant effect of XYS is related to the pharmacological activity of hepatoprotection. The aim of this study was to elucidate the potential link between the antidepressant and hepatoprotective effect of XYS. MATERIALS AND METHODS A depression rat model was established by the CUMS (chronic unpredictable mild stress) procedure. The antidepressant effect of XYS was assessed by the behavioral indicators, and the hepatoprotective effect of XYS was evaluated through biochemical assays. 1H-NMR and LC/MS-based liver metabolomics were performed to discover key metabolic pathways involved in the antidepressant and hepatoprotective effects of XYS. Further, the key pathway was validated using commercial kits. RESULTS The results demonstrated that XYS pretreatment could significantly improve the depressive symptom induced by CUMS. More importantly, the results demonstrated that liver injury was observed in the CUMS model rats, and XYS had a hepatoprotective effect by reducing the activities of AST and ALT in serum, increasing the levels of SOD and GSH-Px and reducing the contents of MDA, IL-6, and IL-1β in the liver. In addition, the NMR and LC/MS-based metabolomics results indicated that XYS improved 23 of the 35 perturbed potential liver biomarkers that were induced by CUMS. Among them, 9 biomarkers were significantly correlated with both depression and liver pathology, according to Pearson correlation analysis. Metabolic pathway analyses of these 9 biomarkers showed that glutamine and glutamate metabolism were the most important metabolic pathways. Furthermore, to verify glutamine and glutamate metabolism, the levels of glutamine and glutamate, and the activity of glutamine synthetase (GS) and glutaminase (GLS) were quantitatively determined in the liver by commercial kits, and these results were consistent with the metabolomics results. CONCLUSIONS XYS could significantly improve the depressive and liver injury symptoms induced by CUMS. The metabolomics results indicate that the regulation of glutamine and glutamate metabolism to maintain the balance of ammonia and promote energy metabolism is a potential junction between the antidepressant and hepatoprotective effects of XYS.
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Affiliation(s)
- Congcong Chen
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, No.92, Wucheng Road, Taiyuan, 030006, PR China; College of Chemistry and Chemical Engineering, Shanxi University, No. 92, Wucheng Road, Taiyuan, 030006, PR China
| | - Qicai Yin
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, No.92, Wucheng Road, Taiyuan, 030006, PR China; College of Chemistry and Chemical Engineering, Shanxi University, No. 92, Wucheng Road, Taiyuan, 030006, PR China
| | - Junshen Tian
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, No.92, Wucheng Road, Taiyuan, 030006, PR China
| | - Xiaoxia Gao
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, No.92, Wucheng Road, Taiyuan, 030006, PR China
| | - Xuemei Qin
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, No.92, Wucheng Road, Taiyuan, 030006, PR China
| | - Guanhua Du
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, No.92, Wucheng Road, Taiyuan, 030006, PR China; Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100050, PR China
| | - Yuzhi Zhou
- Modern Research Center for Traditional Chinese Medicine of Shanxi University, No.92, Wucheng Road, Taiyuan, 030006, PR China.
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Abstract
Patients with chronic liver disease have a very high lifetime risk of malnourishment. It has been increasingly identified in literature that the severity of liver disease affects severity of malnutrition and vice versa. The objective of this review article is to recognize the severity of complications associated with malnutrition in patients with cirrhosis and ways to overcome these obstacles.
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Affiliation(s)
- Aiman Ghufran
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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57
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Zhu LL, Shen JD, Wang BY, Lu SF, Ming B, Xu EP, Li YC, Fang XY. Depressive-like behaviors are induced by chronic liver injury in male and female mice. Neurosci Lett 2020; 718:134750. [PMID: 31926175 DOI: 10.1016/j.neulet.2020.134750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/26/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Depression is a highly prevalent mental disease and increasingly become a global public health problem. Recent studies have shown that the dysfunction of liver was associated with depression. However, the previous studies have not been fully explained the relationship between depression and liver injury. The present study was aimed to investigate whether chronic liver injury could induce depressive-like behavior. Chronic liver injury was induced by intraperitoneal injection of carbon (CCl4), D-galactosamine (D-GalN) and thioacetamide (TAA), respectively. And the results showed that the serum activities of ALT in CCl4, D-GalN and TAA groups were significantly increased in both male and female mice compared with the control group, while the activities of AST increased only in CCl4 group. Meanwhile, H&E staining showed that CCl4, D-GalN and TAA induced hepatocytes injury in both male and female mice. Moreover, the sucrose preference was significantly decreased and the immobility time in forced swimming test and tail suspension test were significantly prolonged in CCl4 and D-GalN group compared with control group. Our findings demonstrated that chronic liver injury induced by CCl4 and D-GalN could induce depressive-like behaviors in mice.
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Affiliation(s)
- Lei-Lei Zhu
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou 450046, PR China
| | - Ji-Duo Shen
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou 450046, PR China
| | - Bao-Ying Wang
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Scientific Research and Experiment Center, Henan University of Chinese Medicine, Zhengzhou 450046, PR China
| | - Shuai-Fei Lu
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou 450046, PR China
| | - Bai Ming
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Scientific Research and Experiment Center, Henan University of Chinese Medicine, Zhengzhou 450046, PR China
| | - Er-Ping Xu
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Scientific Research and Experiment Center, Henan University of Chinese Medicine, Zhengzhou 450046, PR China
| | - Yu-Cheng Li
- Henan Key Laboratory for Modern Research on Zhongjing's Herbal Formulae, Scientific Research and Experiment Center, Henan University of Chinese Medicine, Zhengzhou 450046, PR China.
| | - Xiao-Yan Fang
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou 450046, PR China.
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58
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Zhao BB, Chen LL, Long QH, Xie GJ, Xu B, Li ZF, Wang P, Li H. Preventive Effects of Escitalopram Against Anxiety-Like Depressive Behaviors in Monosodium Glutamate-Teated Rats Subjected to Partial Hepatectomy. Front Psychol 2019; 10:2462. [PMID: 31798487 PMCID: PMC6861546 DOI: 10.3389/fpsyg.2019.02462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/17/2019] [Indexed: 12/15/2022] Open
Abstract
The reasons for the relationship between depression and chronic liver disease (CLD) are complex and multifactorial. Further research is needed to decipher the etiology and establish an optimal management approach for depression in patients, including the potential role of non-pharmacological treatments. monosodium glutamate (MSG)-treated rats are more likely to develop anxiogenic- and depressive-like behaviors, which could be related to the dysfunction of serotonergic system. In this study, partial hepatectomy (PH) was performed in MSG-treated rats and the histopathological changes were observed in orbitofrontal cortex (OFC) and liver. The effect of escitalopram, a widely used antidepressant, on neural and liver injury in this model was also examined. The MSG + PH-treated rats displayed decreased distances traveled in total, in center arena, and in the left side of arena in inner open field test (OFT), as compared to saline, saline + PH, and MSG-treated animals. The present study established that PH aggravated anxiety-like depressive behaviors in MSG-treated rats, concordant with damaged Nissl bodies (and neurites), decreased IBA-1 and Sox-2 expression in OFC and neurotransmitter disorder. Escitalopram treatment could alleviate these pathological changes as well as reduce hepatic steatosis and lipid metabolism.
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Affiliation(s)
- Bin-Bin Zhao
- Hubei University of Chinese Medicine, Wuhan, China
| | - Lin-Lin Chen
- Hubei University of Chinese Medicine, Wuhan, China
| | | | | | - Bo Xu
- Hubei University of Chinese Medicine, Wuhan, China
| | - Ze-Fei Li
- Hubei University of Chinese Medicine, Wuhan, China
| | - Ping Wang
- Hubei University of Chinese Medicine, Wuhan, China
| | - Hanmin Li
- Hubei Hospital of Traditional Chinese Medicine (Affiliated Hospital of Hubei University of Traditional Chinese Medicine), Hubei University of Chinese Medicine, Wuhan, China
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59
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Wyska E. Pharmacokinetic considerations for current state-of-the-art antidepressants. Expert Opin Drug Metab Toxicol 2019; 15:831-847. [DOI: 10.1080/17425255.2019.1669560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Elżbieta Wyska
- Department of Pharmacokinetics and Physical Pharmacy, Jagiellonian University Medical College, Kraków, Poland
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60
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End-stage liver disease in alcohol-dependent patients. NEUROPSYCHIATRIE 2019; 33:160-164. [PMID: 31218547 PMCID: PMC6744388 DOI: 10.1007/s40211-019-0314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/27/2019] [Indexed: 11/05/2022]
Abstract
This case report is about a 44-year-old woman with alcohol-related end-stage liver disease. Initial contact with the patient was made in the alcohol-outpatient clinic of the Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna. Due to a particularly poor general condition, Child Pugh Score C/MELD Score 20, the patient was admitted to ward 4A, with the clinical and scientific focus of treating patients with alcohol use disorder. The withdrawal process was complicated by a multitude of factors associated with end-stage liver disease. By explaining the theoretical background of possible somatic as well as psychiatric complications of end-stage liver disease and elaborating on treatment options a comprehensive overview of the psychiatric and somatic management of this patient population is given.
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61
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Boglione L, Lupia T, Cariti G, Di Perri G. Efficacy and safety of interferon-free regimens in patients affected by chronic hepatitis C and psychiatric disorders. J Infect Chemother 2019; 26:18-22. [PMID: 31301972 DOI: 10.1016/j.jiac.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/24/2019] [Accepted: 06/09/2019] [Indexed: 02/08/2023]
Abstract
The presence of psychiatric disorders (PD) in patients affected by chronic hepatitis C (CHC) was a major contraindication for the treatment with interferon (IFN)-based regimens. The novel IFN-free approach using the direct-acting antiviral agents (DAAs) is an interesting and promising chance for these subjects. In this retrospective analysis we focused the attention on the virological response and safety of CHC patients affected by PD and treated with IFN-free regimens. 136 subjects were enrolled in this study. Treatment naïve were 78 (57.3), experienced 58 (42.6%). Major depression was present in 25 patients (18.4%), anxiety disorders in 37 (27.2%), bipolar disorders in 23 (16.9%), schizophrenia in 17 (12.5%), behavioral disturbance in 21 (15.4%), psychosis in 13 (9.5%). Psychoactive medication taken by patients were: benzodiazepines (n = 29, 21.3%), antidepressants (n = 24, 17.6%), neuroleptics (n = 29, 21.3%), mood stabilizers (n = 19, 14%), combinations of different drugs (n = 17, 12.5%). Sustained virological response at 12 weeks of follow-up (SVR12) was observed in 128 patients (94.1%), drop-out were 3 (2.2%). No adverse events or significant drug-related side-effects were reported. The treatment with novel IFN-free therapies against CHC were higher effective and well tolerated also in patients with PD taking psychoactive medications.
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Affiliation(s)
- Lucio Boglione
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy.
| | - Tommaso Lupia
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Giuseppe Cariti
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
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62
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Neong SF, Billington EO, Congly SE. Sexual Dysfunction and Sex Hormone Abnormalities in Patients With Cirrhosis: Review of Pathogenesis and Management. Hepatology 2019; 69:2683-2695. [PMID: 30468515 DOI: 10.1002/hep.30359] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/06/2018] [Indexed: 02/06/2023]
Abstract
Healthy sexual function is important to maintain a good quality of life but is frequently impaired in patients with cirrhosis. The degree of sexual dysfunction appears to be linked with the degree of hepatic dysfunction. In men, sexual dysfunction can be related to the hyperestrogenism of portal hypertension and/or to decreased testosterone resulting from testicular dysfunction. In women, suppression of the hypothalamic-pituitary-gonadal axis appears to be a principal contributor, with no significant effect of portal hypertension. There is also a huge psychological barrier to break through as there is a component of depression in many patients with cirrhosis. Sexual dysfunction is often underdiagnosed in the cohort with cirrhosis. Management of sexual disorders in patients with cirrhosis can be challenging as they are often multifactorial. A multidisciplinary approach is key in managing these patients. We review the current literature on the pathogenesis of sexual dysfunction in patients with cirrhosis and propose a stepwise algorithm to better manage these patients.
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Affiliation(s)
- Shuet Fong Neong
- Multiorgan Transplant, University Health Network, Division of Gastroenterology and Hepatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emma O Billington
- Division of Endocrinology & Metabolism, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen E Congly
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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63
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Verma M, Horrow J, Navarro V. A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease. Hepatol Commun 2019; 3:646-655. [PMID: 31061953 PMCID: PMC6492470 DOI: 10.1002/hep4.1328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/22/2019] [Indexed: 01/19/2023] Open
Abstract
Alcohol use disorder, substance abuse, and depression are illnesses that deteriorate the quality of life (QOL) of patients with chronic liver disease (CLD). Screening and behavioral health programs integrated into routine practice can mitigate the deleterious effects of such illnesses but have not been adopted in hepatology practices. We implemented a behavioral health program based on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model and assessed its acceptability and effectiveness in improving QOL. This was a quality improvement study. Patients with CLD and a scheduled outpatient visit in the hepatology clinic were screened while waiting for their appointment. All patients who screened positive for any of the three illnesses were offered a brief intervention (BI) at the point of care and at 3 months by a trained social worker. The BI used the principles of motivational interviewing and cognitive behavioral therapy. Severity of illness was assessed at baseline, 3 months, and 6 months. Participants completed an acceptability survey at 6 months. We screened 303 patients; 61.7% were positive for any of the three illnesses assessed. Among the positive patients, depression was most common (48.4%), alcohol and substance abuse were each 26%. For the 95 patients who underwent BI, QOL improved from baseline to 3 and 6 months (P < 0.001) and patients with depression improved the most. Depression was the only independent predictor of change in QOL over time. Of the enrolled patients, 82% agreed BIs improved their overall care and 87% indicated a desire to continue with the behavioral program. Conclusion: An outpatient behavioral health program based on the SBIRT model is acceptable to patients with CLD and may help improve QOL over time.
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Affiliation(s)
- Manisha Verma
- Department of Digestive Diseases and Transplantation Einstein Medical Center Philadelphia PA
| | - Jay Horrow
- Department of Anesthesiology and Perioperative Medicine Drexel University Philadelphia PA
| | - Victor Navarro
- Department of Digestive Diseases and Transplantation Einstein Medical Center Philadelphia PA
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64
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Vu TTM, Le TV, Dang AK, Nguyen LH, Nguyen BC, Tran BX, Latkin CA, Ho CSH, Ho RCM. Socioeconomic Vulnerability to Depressive Symptoms in Patients with Chronic Hepatitis B. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020255. [PMID: 30658423 PMCID: PMC6352008 DOI: 10.3390/ijerph16020255] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 12/17/2022]
Abstract
Depression is considered one of the most prevalent psychiatric disorders among patients with hepatitis B virus (HBV)-related liver disease and has adverse effects on the disease progression. However, there is a scarcity of studies contributing to the assessement of depression in hepatitis B patients. There is also little research into risk factors, particularly underlying socio-economic factors in Vietnam where the prevalence of hepatitis B is high. This study aimed to examine depression and identify whether differences in socio-economic status is related to the level of depression amongst chronic hepatitis B patients. A cross-sectional study was conducted on 298 patients with chronic hepatitis B at The Chronic Hepatitis Clinic in the Viet-Tiep Hospital, Hai Phong, Vietnam. The Patient Health Questionnaire-9 (PHQ-9) and EuroQol-5 dimensions-5 levels (EQ-5D-5L) were used to assess the severity of depression and health-related quality of life (HRQOL). Of chronic hepatitis B patients, 37.5% experienced depressive symptoms and most of them suffered minimal depressive symptoms (31.4%). According to the result of the multivariate logistic regression model, we found that higher age, lower income level, unemployement, living with spouse/partners were positively associated with having depression. Furthermore, having physical health problems and lower health-related quality of life were also related to a higher risk of depression. We recommend family support, financial support and active participation in consultation should be conducted during treatment to improve the quality of life and the emotional state of HBV patients.
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Affiliation(s)
| | - Thieu Van Le
- Viet-Tiep Friendship Hospital, Hai Phong 180000, Vietnam.
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam.
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
| | | | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam.
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore.
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam.
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
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Buganza-Torio E, Mitchell N, Abraldes JG, Thomas L, Ma M, Bailey RJ, Tandon P. Depression in cirrhosis - a prospective evaluation of the prevalence, predictors and development of a screening nomogram. Aliment Pharmacol Ther 2019; 49:194-201. [PMID: 30485460 DOI: 10.1111/apt.15068] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/09/2018] [Accepted: 10/29/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depression is associated with substantial morbidity and mortality in cirrhosis, but is underdiagnosed and undertreated. AIMS Using the Mini International Neuropsychiatric Interview (MINI) as a gold-standard, to determine prevalence, predictors, and outcomes of depression, and to develop a screening nomogram for use in cirrhosis patients. METHODS Cirrhotic outpatients 18-80 years of age, not on anti-depressants, were consecutively recruited from liver clinics at three tertiary care hospitals. Baseline health-related quality of life (HRQoL) and frailty were determined by the chronic liver disease questionnaire, EQ-VAS, Clinical Frailty Scale and Fried Frailty Criteria. Depression was identified using the MINI and participants were followed up to 6 months to determine unplanned hospitalization/death. RESULTS Of 305 patients, 62% were male; mean age 55(10) years; mean MELD 12.5(5), 61% Child Pugh B/C. Prevalence of depression 18% by MINI. Patients with depression had lower baseline HRQoL and higher frailty scores. Five independently predictive factors were used to develop a clinical nomogram for the diagnosis of clinical depression. These included three Hospital Anxiety and Depression Screening tool variables: "I have lost interest in my appearance" (adjusted odds ratio [aOR] 2.2, P = 0.006), "I look forward with enjoyment to things" (aOR 2.0, P = 0.02), "I feel cheerful" (aOR 2.8, P = 0.002), and two demographic variables: younger age (aOR 0.92, P = 0.001) and not being married or in a common-law relationship (aOR 0.30, P = 0.008). CONCLUSIONS Depression is common in patients with cirrhosis. It has a significant impact on HRQoL and functional status. The developed clinical nomogram is promising for the rapid screening of depression in patients with cirrhosis.
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Affiliation(s)
- Elizabeth Buganza-Torio
- Department of Medicine, Cirrhosis Care Clinic, University of Alberta, Edmonton, Alberta.,Liver Transplant Unit, University of Alberta, Edmonton, Alberta
| | - Nicholas Mitchell
- Liver Transplant Unit, University of Alberta, Edmonton, Alberta.,Department of Psychiatry, University of Alberta, Edmonton, Alberta
| | - Juan G Abraldes
- Department of Medicine, Cirrhosis Care Clinic, University of Alberta, Edmonton, Alberta.,Liver Transplant Unit, University of Alberta, Edmonton, Alberta
| | - Lesley Thomas
- Department of Medicine, Cirrhosis Care Clinic, University of Alberta, Edmonton, Alberta
| | - Mang Ma
- Department of Medicine, Cirrhosis Care Clinic, University of Alberta, Edmonton, Alberta
| | | | - Puneeta Tandon
- Department of Medicine, Cirrhosis Care Clinic, University of Alberta, Edmonton, Alberta.,Liver Transplant Unit, University of Alberta, Edmonton, Alberta
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Protective Effects of Liu Wei Di Huang Wan on the Liver, Orbitofrontal Cortex Nissl Bodies, and Neurites in MSG+PH-Induced Liver Regeneration Rat Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:9090128. [PMID: 30224933 PMCID: PMC6129786 DOI: 10.1155/2018/9090128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/03/2018] [Indexed: 01/05/2023]
Abstract
Introduction. To examine the protective effects of Liu Wei Di Huang Wan formula (LWDH) on liver and orbitofrontal cortex (OFC) injuries in monosodium glutamate (MSG) and partial hepatectomy (PH) rat model. Methods. Neonatal Wistar rats were given MSG or saline on postnatal days 2, 4, 6, 8, and 10. The rats were caged into five groups and treated accordingly at six weeks old as follows: Saline group, Saline+PH group, MSG group, MSG+PH group, and LWDH group (MSG+PH+LWDH). The PH was performed during week 8 by excision of the left and median hepatic lobes (occupying about 68% of whole liver).On day 8 after the PH, the rats were subjected to an inner OFT before being sacrificed. The liver and OFC were stained using H&E, ORO, or Nissl staining. The expression of neurotrophic factors (β-NGF, BDNF) was examined in the OFC lysates by ELISA. Serum levels of cytokines (IL-1β, VEGF) were examined using the Bio-Plex suspension array. Results. LWDH increased the total distance traveled by the animals (p<0.05), and LWDH improved the integrity of the Nissl bodies in the OFC (mean area of the Nissl bodies, p<0.01; mean diameter, p<0.05; mean density, p<0.05; and IOD, p<0.01). There were less white area in the liver (p>0.05) and decreased hepatic steatosis (p<0.01) in LWDH group. LWDH administration decreased the expression of serum levels of IL-1β (p>0.05), while it increased VEGF (p>0.05) expression. LWDH administration increased the expression of BDNF (p>0.05) and β-NGF (p>0.05) in the OFC, all as compared to the MSG+PH group. Conclusion. LWDH partly protected the animals from depressive-like behaviors in the MSG+PH-induced liver regeneration neonatal rat model. LWDH alleviated hepatic injury and steatosis and, furthermore, protected the Nissl body integrity and the growth of neurites.
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Shaheen AA, Kaplan GG, Almishri W, Vallerand I, Frolkis AD, Patten S, Swain MG. The impact of depression and antidepressant usage on primary biliary cholangitis clinical outcomes. PLoS One 2018; 13:e0194839. [PMID: 29617396 PMCID: PMC5884515 DOI: 10.1371/journal.pone.0194839] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/14/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Depression is prevalent in primary biliary cholangitis (PBC) patients. Our aims were to examine the effects of depression and antidepressants on hepatic outcomes of PBC patients. METHODS We used the UK Health Improvement Network database to identify PBC patients between 1974 and 2007. Our primary outcome was one of three clinical events: decompensated cirrhosis, liver transplantation and death. We assessed depression and each class of antidepressant medication in adjusted multivariate Cox proportional hazards models to identify independent predictors of outcomes. In a sensitivity analysis, the study population was restricted to PBC patients using ursodeoxycholic acid (UDCA). RESULTS We identified 1,177 PBC patients during our study period. In our cohort, 86 patients (7.3%) had a depression diagnosis prior to PBC diagnosis, while 79 patients (6.7%) had a depression diagnosis after PBC diagnosis. Ten-year incidence of mortality, decompensated cirrhosis, and liver transplantation were 13.4%, 6.6%, and 2.0%, respectively. In our adjusted models, depression status was not a predictor of poor outcomes. After studying all classes of antidepressants, using the atypical antidepressant mirtazapine after PBC diagnosis was significantly protective (Adjusted HR 0.23: 95% CI 0.07-0.72) against poor liver outcomes (decompensation, liver transplant, mortality), which remained statistically significant in patients using UCDA (HR 0.21: 95% CI 0.05-0.83). CONCLUSIONS In our study, depression was not associated with poor clinical outcomes. However, using the antidepressant mirtazapine was associated with decreased mortality, decompensated cirrhosis and liver transplantation in PBC patients. These findings support further assessment of mirtazapine as a potential treatment for PBC patients.
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Affiliation(s)
- Abdel-Aziz Shaheen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Gilaad G. Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Wagdi Almishri
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Isabelle Vallerand
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra D. Frolkis
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Scott Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Mark G. Swain
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Serigado JM, Barboza KC, Marcus P, Sigal SH. Clinical Impact of Depression in Cirrhosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11901-018-0386-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Henson JB, Brown CL, Chow SC, Muir AJ. Complementary and Alternative Medicine Use in United States Adults With Liver Disease. J Clin Gastroenterol 2017; 51:564-570. [PMID: 27479144 PMCID: PMC7245507 DOI: 10.1097/mcg.0000000000000617] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
GOALS To describe the complementary and alternative medicine (CAM) use in US adults with liver disease. BACKGROUND The prevalence and patterns of CAM use among US adults with liver disease have not been well characterized. The 2012 National Health Interview Survey is considered the most current and comprehensive source of information on CAM use in US adults. STUDY Using the results of the 2012 National Health Interview Survey, the prevalence of CAM use, most common modalities used, reasons for CAM use, perceived benefits, perceived helpfulness and importance, and disclosure of CAM to health care providers were compared between adults with and without liver disease. RESULTS Of the 647 adults with liver disease, 41% reported using CAM in the prior year, compared with 33% of adults without liver disease. The most common modality was herbs and supplements (23%), and 3% of respondents reported consumption of a potentially hepatotoxic substance in the previous 30 days. Only a small proportion of CAM therapies were used specifically for liver disease, with milk thistle being the most common. Among respondents with liver disease, CAM was used more commonly for anxiety or depression, fatigue, and substance use. The majority believed that these therapies improved health. Nearly one-third of therapies were not reported to health care providers, mostly due to failure of the provider to ask. CONCLUSIONS CAM use, particularly herbs and supplements, is prevalent among US adults with liver disease. Many do not disclose their CAM use to their providers, despite some using potentially hepatotoxic substances.
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Affiliation(s)
- Jacqueline B. Henson
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine
| | | | - Shein-Chung Chow
- Department of Biostatistics and Department of Bioinformatics, Duke University School of Medicine
| | - Andrew J. Muir
- Department of Medicine, Division of Gastroenterology
- Duke Clinical Research Institute, Durham, NC
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Carcinome hépatocellulaire : quels soins de confort ? ONCOLOGIE 2017. [DOI: 10.1007/s10269-017-2714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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71
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Huang X, Liu X, Yu Y. Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms? Front Mol Neurosci 2017; 10:134. [PMID: 28533742 PMCID: PMC5420567 DOI: 10.3389/fnmol.2017.00134] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022] Open
Abstract
The occurrence of depression is higher in patients with chronic liver disease (CLD) than that in the general population. The mechanism described in previous studies mainly focused on inflammation and stress, which not only exists in CLD, but also emerges in common chronic diseases, leaving the specific mechanism unknown. This review was to summarize the prevalence and risk factors of depression in CLD including chronic hepatitis B, chronic hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, and to point out the possible underlying mechanism of this potential link. Clarifying the origins of this common comorbidity (depression and CLD) may provide more information to understand both diseases.
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Affiliation(s)
- Xiaoqin Huang
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - Xiaoyun Liu
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical UniversityHefei, China
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Carrier P, Debette-Gratien M, Girard M, Jacques J, Nubukpo P, Loustaud-Ratti V. Liver Illness and Psychiatric Patients. HEPATITIS MONTHLY 2016; 16:e41564. [PMID: 28123443 PMCID: PMC5237472 DOI: 10.5812/hepatmon.41564] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/30/2016] [Accepted: 11/14/2016] [Indexed: 12/11/2022]
Abstract
Patients with psychiatric disorders are usually more exposed to multiple somatic illnesses, including liver diseases. Specific links are established between psychiatric disorders and alcohol hepatitis, hepatitis B, and hepatitis C in the population as a whole, and specifically in drug abusers. Metabolic syndrome criteria, and associated steatosis or non-alcoholic steato-hepatitis (NASH) are frequent in patients with chronic psychiatric disorders under psychotropic drugs, and should be screened. Some psychiatric medications, such as neuroleptics, mood stabilizers, and a few antidepressants, are often associated with drug-induced liver injury (DILI). In patients with advanced chronic liver diseases, the prescription of some specific psychiatric treatments should be avoided. Psychiatric disorders can be a limiting factor in the decision-making and following up for liver transplantation.
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Affiliation(s)
- Paul Carrier
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
- INSERM, U850, F-87000 Limoges, Univ Limoges, France
- Corresponding Author: Paul Carrier, Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France. Tel: +33-555056687, Fax: +33-555056767, E-mail: ;
| | - Marilyne Debette-Gratien
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
- INSERM, U850, F-87000 Limoges, Univ Limoges, France
| | - Murielle Girard
- Unité D’investigation Clinique, Centre Hospitalier Spécialisé Esquirol, 87042 Limoges, France
| | - Jérémie Jacques
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
| | - Philippe Nubukpo
- Pôle D’addictologie, Centre Hospitalier Spécialisé Esquirol, 87042 Limoges, France
| | - Véronique Loustaud-Ratti
- Service D’hépato-Gastroentérologie, CHU Limoges, 87042 Limoges Cédex, France
- INSERM, U850, F-87000 Limoges, Univ Limoges, France
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Rogal SS, Mankaney G, Udawatta V, Chinman M, Good CB, Zickmund S, Bielefeldt K, Chidi A, Jonassaint N, Jazwinski A, Shaikh O, Hughes C, Fontes P, Humar A, DiMartini A. Pre-Transplant Depression Is Associated with Length of Hospitalization, Discharge Disposition, and Survival after Liver Transplantation. PLoS One 2016; 11:e0165517. [PMID: 27820828 PMCID: PMC5098732 DOI: 10.1371/journal.pone.0165517] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/13/2016] [Indexed: 01/10/2023] Open
Abstract
Depression after liver transplantation has been associated with decreased survival, but the effects of pre-transplant depression on early and late post-transplant outcomes remain incompletely evaluated. We assessed all patients who had undergone single-organ liver transplantation at a single center over the prior 10 years. A diagnosis of pre-transplant depression, covariates, and the outcomes of interest were extracted from the electronic medical record. Potential covariates included demographics, etiology and severity of liver disease, comorbidities, donor age, graft type, immunosuppression, and ischemic times. In multivariable models adjusting for these factors, we evaluated the effect of pre-transplant depression on transplant length of stay (LOS), discharge disposition (home vs. facility) and long-term survival. Among 1115 transplant recipients with a median follow-up time of 5 years, the average age was 56±11 and MELD was 12±9. Nineteen percent of the study population had a history of pre-transplant depression. Pre-transplant depression was associated with longer LOS (median = 19 vs. 14 days, IRR = 1.25, CI = 1.13,1.39), discharge to a facility (36% vs. 25%, OR 1.70,CI = 1.18,2.45), and decreased survival (HR = 1.54,CI = 1.14,2.08) in this cohort, accounting for other potential confounders. In conclusion, pre-transplant depression was significantly associated with longer transplant length of stay, discharge to a facility, and mortality in this cohort.
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Affiliation(s)
- Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
| | - Gautham Mankaney
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Viyan Udawatta
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Matthew Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Rand Corporation, Pittsburgh, PA, United States of America
| | - Chester B. Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Susan Zickmund
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Klaus Bielefeldt
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Alexis Chidi
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Naudia Jonassaint
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Alison Jazwinski
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Obaid Shaikh
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Christopher Hughes
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Paulo Fontes
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Andrea DiMartini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America
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ELnahas EM, Zeid MSA, Kawy HSA, Hendawy N, Baher W. Celecoxib attenuates depressive-like behavior associated with immunological liver injury in C57BL/6 mice through TNF-α and NF-κb dependent mechanisms. Life Sci 2016; 163:23-37. [PMID: 27580523 DOI: 10.1016/j.lfs.2016.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/23/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
Abstract
AIM Depression associating patients with chronic liver diseases is a major treatment goal. This study aimed to evaluate the potential hepatoprotective and antidepressant effects of celecoxib in a model of experimental autoimmune hepatitis (EAH) and depressive-like behavior in C57BL/6 mice. MAIN METHODS EAH was induced by immunization with S-100 liver antigen emulsified in complete Freund's adjuvant (CFA). Mice were randomly allocated to 5 groups; control phosphate buffered saline group; control CFA group; EAH group, and 2 groups of EAH plus celecoxib (7.5 or 15mg/kg/d respectively). Mice were assessed behaviorally by novelty-suppressed test, tail suspension test, locomotor assessment and forced swimming tests. Serum liver enzymes and hepatic hydroxyproline content were biochemically analyzed. Histopathological analysis for liver and brain sections and immunohistochemical studies for hepatic and hippocampal tumor necrosis factor (TNF-α), nuclear factor Kappa-B (NF-κB) and caspase-3 were performed. KEY FINDINGS EAH group exhibited significant depressive-like changes, increase in liver enzymes and hepatic hydroxyproline content. Signs of autoimmune hepatitis and structural changes in hippocampus were confirmed by histopathological studies. Immunohistochemical examination revealed overexpression of hepatic and hippocampal TNF-α, NF-κB and caspase-3 positive cells. Celecoxib (7.5mg/kg/d) significantly ameliorated hepatic biochemical changes, hepatic and hippocampal histopathological and immunohistochemical changes induced in EAH group. Celecoxib (15mg/kg/d) significantly ameliorated the behavioral changes, histopathological and immunohistochemical changes in hippocampus, with non-significant change in hepatic biochemical profile, histopathological and immunohistochemical changes induced in EAH group. SIGNIFICANCE The celecoxib (7.5mg/kg/d) through its anti-inflammatory effect may represent a new therapeutic approach to treat autoimmune hepatitis associated with depressive symptoms.
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Affiliation(s)
| | | | | | - Nevien Hendawy
- Pharmacology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
| | - Walaa Baher
- Histolology & Cell Biology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Barboza KC, Salinas LM, Sahebjam F, Jesudian AB, Weisberg IL, Sigal SH. Impact of depressive symptoms and hepatic encephalopathy on health-related quality of life in cirrhotic hepatitis C patients. Metab Brain Dis 2016; 31:869-80. [PMID: 27032930 DOI: 10.1007/s11011-016-9817-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/01/2016] [Indexed: 02/06/2023]
Abstract
Depression, common in chronic medical conditions, and hepatic encephalopathy (HE), a reversible neuropsychiatric syndrome due to liver dysfunction, are associated with impaired health-related quality of life (HRQOL) in cirrhosis and hepatitis C (HCV). This study investigated the impact of depression and HE on HRQOL in cirrhotic patients with HCV. A convenience sample of 43 ambulatory patients, with varying degrees of cirrhosis secondary to HCV, was prospectively enrolled in this study. Participants were assessed for any current depressive, fatigue, and daytime sleepiness symptoms and underwent a psychometric evaluation to determine the presence of HE symptoms. Participants reported current HRQOL on general health and liver disease-specific questionnaires. Diagnosis and current health status were confirmed via medical records. The associations between disease severity, depressive symptoms, HE, fatigue, and daytime sleepiness were measured. Predictors of HRQOL in this sample were determined. Depressive symptoms (70 %) and HE (77 %) were highly prevalent in this sample, with 58 % actively experiencing both conditions at the time of study participation. A significant positive association was found between depressive symptoms and HE severity (P = .05). Depressive symptoms were significantly associated with fatigue (P < .001), daytime sleepiness (P < .001), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). HE was significantly associated with fatigue (P = .02), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). Depressive symptoms and HE were significant predictors of reduced HRQOL (P < .001), with depressive symptoms alone accounting for 58.8 % of the variance. Depressive symptoms and HE accounted for 68.0 % of the variance. Findings suggest a possible pathophysiological link between depression and HE in cirrhosis, and potentially a wider-reaching benefit of treating minimal and overt HE than previously appreciated.
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Affiliation(s)
- Katherine C Barboza
- Department of Medicine, New York University Langone Medical Center, New York City, NY, USA.
| | - Lilian M Salinas
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, NY, USA
| | - Farhad Sahebjam
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, NY, USA
| | - Arun B Jesudian
- Center for Liver Disease and Transplantation, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Ilan L Weisberg
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, New York, USA
| | - Samuel H Sigal
- Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York City, NY, USA
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Åberg F. From prolonging life to prolonging working life: Tackling unemployment among liver-transplant recipients. World J Gastroenterol 2016; 22:3701-3711. [PMID: 27076755 PMCID: PMC4814733 DOI: 10.3748/wjg.v22.i14.3701] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/19/2016] [Accepted: 03/02/2016] [Indexed: 02/06/2023] Open
Abstract
Return to active and productive life is a key goal of modern liver transplantation (LT). Despite marked improvements in quality of life and functional status, a substantial proportion of LT recipients are unable to resume gainful employment. Unemployment forms a threat to physical and psychosocial health, and impairs LT cost-utility through lost productivity. In studies published after year 2000, the average post-LT employment rate is 37%, ranging from 22% to 55% by study. Significant heterogeneity exists among studies. Nonetheless, these employment rates are lower than in the general population and kidney-transplant population. Most consistent employment predictors include pre-LT employment status, male gender, functional/health status, and subjective work ability. Work ability is impaired by physical fatigue and depression, but affected also by working conditions and society. Promotion of post-LT employment is hampered by a lack of interventional studies. Prevention of pre-LT disability by effective treatment of (minimal) hepatic encephalopathy, maintaining mobility, and planning work adjustments early in the course of chronic liver disease, as well as timely post-LT physical rehabilitation, continuous encouragement, self-efficacy improvements, and depression management are key elements of successful employment-promoting strategies. Prolonging LT recipients’ working life would further strengthen the success of transplantation, and this is likely best achieved through multidisciplinary efforts ideally starting even before LT candidacy.
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78
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Stokes CS, Grünhage F, Baus C, Volmer DA, Wagenpfeil S, Riemenschneider M, Lammert F. Vitamin D supplementation reduces depressive symptoms in patients with chronic liver disease. Clin Nutr 2015. [PMID: 26212170 DOI: 10.1016/j.clnu.2015.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Vitamin D deficiency and depression frequently occur in patients with chronic liver diseases (CLD). Depression has recently been inversely associated with vitamin D in a meta-analysis, and vitamin D receptor is expressed in brain. This pilot study investigates whether vitamin D replacement ameliorates depressive symptoms in CLD patients and consists of a cross-sectional and an interventional analysis. METHODS Overall, 111 patients with CLD were included in the cross-sectional analysis. The Beck Depression Inventory II (BDI-II) was used to assess depression. Chemiluminescence immunoassay and LC-MS/MS quantified serum 25-hydroxyvitamin D levels. For the interventional analysis, 77 patients with inadequate vitamin D concentrations received 20,000 IU vitamin D per week for six months. The final follow-up was carried out six months post supplementation. RESULTS In the cross-sectional analysis, 81% of patients (median age 55 years, 47% women) had inadequate baseline vitamin D levels (<30 ng/ml), and 31% presented with depressive symptoms (BDI-II score ≥14). Depression severity correlated inversely with vitamin D level in depressed patients (β = -0.483, P = 0.004). Depression scores improved significantly from baseline in depressed patients after three and six months (P = 0.003 and P = 0.004, respectively) of supplementation, with vitamin D levels increasing to normal (P < 0.0001). Subgroup analyses revealed this anti-depressant effect of vitamin D to occur predominantly in women. The final follow-up showed increases in median BDI-II scores in the setting of decreased vitamin D levels. CONCLUSIONS Vitamin D levels correlated with BDI-II scores, and vitamin D replacement significantly improved depressive symptoms in women with CLD. Adjuvant vitamin D may be considered in these patients. REGISTRATION NO DRKS00007782 German Clinical Trials Registry (DRKS).
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Affiliation(s)
- Caroline S Stokes
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
| | - Frank Grünhage
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Crystal Baus
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Dietrich A Volmer
- Institute of Bioanalytical Chemistry, Saarland University, Saarbrücken, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, Germany
| | - Matthias Riemenschneider
- Department of Psychiatry and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
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79
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Chobanyan-Jürgens K, Leiskau C, Sabau R, Stichtenoth DO. Letter: depression and the use of anti-depressants in patients with chronic liver disease or liver transplantation. Aliment Pharmacol Ther 2015; 41:913-4. [PMID: 25846392 DOI: 10.1111/apt.13138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- K Chobanyan-Jürgens
- Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany.
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80
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Dew MA, Rosenberger EM, Myaskovsky L, DiMartini AF, DeVito Dabbs AJ, Posluszny DM, Steel J, Switzer GE, Shellmer DA, Greenhouse JB. Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta-Analysis. Transplantation 2015; 100:988-1003. [PMID: 26492128 PMCID: PMC4840103 DOI: 10.1097/tp.0000000000000901] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks after transplantation. If such associations exist, additional risk reduction strategies may be needed. METHODS Four bibliographic databases were searched from 1981 through September 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for posttransplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. RESULTS Twenty-seven studies (10 heart, total n = 1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas, n = 80; 1 mixed recipient sample, n = 205) were identified. In each, depression and/or anxiety were typically measured before or early after transplantation. Follow-up for outcomes was a median of 5.8 years (range, 0.50-18.0). Depression increased the relative risk (RR) of mortality by 65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (vs did not) control for potential confounders (P = .032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR, 1.65; 95% CI, 1.21-2.26, 3 studies). Depression was not associated with other morbidities (each morbidity was assessed in 1-4 studies). Anxiety did not significantly increase mortality risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed in single studies). CONCLUSIONS Depression increases risk for posttransplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce posttransplant mortality requires study.
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Affiliation(s)
- Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics,
and Clinical and Translational Science, University of Pittsburgh
| | - Emily M. Rosenberger
- Clinical and Translational Science Institute, and Department of
Medicine, University of Pittsburgh
| | - Larissa Myaskovsky
- Department of Medicine, University of Pittsburgh, and Center for
Health Equity Research and Promotion, Veterans Administration Pittsburgh
Healthcare System
| | | | | | | | - Jennifer Steel
- Departments of Surgery, Psychiatry and Psychology, University of
Pittsburgh
| | - Galen E. Switzer
- Department of Medicine, University of Pittsburgh, and Center for
Health Equity Research and Promotion, Veterans Administration Pittsburgh
Healthcare System
| | | | - Joel B. Greenhouse
- Department of Statistics, Carnegie Mellon University Department of
Psychiatry, University of Pittsburgh
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81
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Mullish BH, Kabir MS, Thursz MR, Dhar A. Letter: depression and the use of anti-depressants in patients with chronic liver disease or liver transplantation - authors' reply. Aliment Pharmacol Ther 2015; 41:914-5. [PMID: 25846393 DOI: 10.1111/apt.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- B H Mullish
- Section of Hepatology, Faculty of Medicine, Imperial College London, London, UK.
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82
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Abstract
Liver disease results in over four million physician visits and over 750,000 hospitalizations per year in the USA. Those with chronic liver disease frequently progress to cirrhosis, end-stage liver disease (ESLD), and death. Patients with ESLD experience numerous complications, including muscle cramps, confusion (hepatic encephalopathy), protein calorie malnutrition, muscle wasting, fluid overload (ascites, edema), bleeding (esophagogastric variceal hemorrhage), infection (spontaneous bacterial peritonitis), fatigue, anxiety, and depression. Despite significant improvements in palliation of these complications, patients still suffer reduced quality of life and must confront the fact that their disease will often inexorably progress to death. Liver transplantation is a valid option in this setting, increasing the duration of survival and palliating many of the symptoms. However, many patients die waiting for an organ or are not candidates for transplantation due to comorbid illness. Others receive a transplant but succumb to complications of the transplant itself. Patients and families must struggle with simultaneously hoping for a cure while facing a life-threatening illness. Ideally, the combination of palliative care with life-sustaining therapy can maximize the patients' quality and quantity of life. If it becomes clear that life-sustaining therapy is no longer an option, these patients are then already in a system to help them with end-of-life care.
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Affiliation(s)
- Anne M Larson
- Swedish Liver Center, 1101 Madison Street #200, Seattle, WA, 98104, USA,
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