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Lai Q, Li W, He X, Wang H, He Q, Hao C, Deng Z. Leisure-time physical activity is associated with depressive symptoms in cancer patients: Data from the NHANES 2007-2018. J Affect Disord 2024; 358:35-41. [PMID: 38705529 DOI: 10.1016/j.jad.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/08/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Cancer patients have a higher risk of depression and are associated with severe adverse prognosis. The relationship between leisure-time physical activity (LTPA) and depressive symptoms in cancer patients is currently unclear. Therefore, our study mainly explores the potential association between LTPA and the weekly cumulative time of LTPA with depressive symptoms in cancer patients. METHODS We included and analyzed 3368 cancer patients (aged >20 years) from the National Health and Nutrition Examination Survey (NHANES) of the United States from 1999 to 2018. The LTPA score was evaluated through a self-report questionnaire, while depressive symptoms were evaluated through the Health Questionnaire-9 (PHQ-9). Multiple logistic regression analysis was used to explore the relationship between LTPA duration and the occurrence of cancer-related depressiive symptoms. Linear correlation was studied using the restricted cubic spline method. RESULTS According to a fully adjusted multivariate logistic regression model with confounding variables, the odds ratio (OR) between LTPA and depressive symptoms in cancer patients in this study was 0.59 (95 % confidence interval = 0.39, 0.92; P = 0.02). When the LTPA level was ≥300 min/week, the incidence of depressive symptoms was reduced by 59 % (OR = 0.41, 95 % CI = 0.21, 0.83). In addition, the cubic spline method was used to obtain a linear negative correlation between LTPA duration and tumor depressive symptoms. CONCLUSION LTPA was negatively correlated with cancer-related depressive symptoms, and the cumulative time of LTPA/week was linearly correlated with depressive symptoms. The slope of the benefit curve changed significantly when the cumulative time of LTPA reached 600 min per week, suggesting that appropriately increasing LTPA had significant benefits on mental health of cancer patients.
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Affiliation(s)
- Qun Lai
- Department of Hematology and Oncology, Third People's Hospital of Zigong, Zigong, Sichuan 643000, China
| | - Wenqiang Li
- Department of Pulmonary and Critical Care Medicine, First People's Hospital of Zigong, 42 Shangyihao Yizhi Street, Zigong, Sichuan 643000, China
| | - Xiaoyu He
- Department of Pulmonary and Critical Care Medicine, First People's Hospital of Zigong, 42 Shangyihao Yizhi Street, Zigong, Sichuan 643000, China; North Sichuan Medical College, Nanchong, Sichuan 637100, China
| | - Hongping Wang
- Department of Neurosurgery, Fourth People's Hospital of Zigong, Zigong, Sichuan 643000, China
| | - Qian He
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, Sichuan 610000, China
| | - Chengluo Hao
- Department of Hematology and Oncology, Third People's Hospital of Zigong, Zigong, Sichuan 643000, China.
| | - Zhiping Deng
- Department of Pulmonary and Critical Care Medicine, First People's Hospital of Zigong, 42 Shangyihao Yizhi Street, Zigong, Sichuan 643000, China.
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Lee H, Kennedy CJ, Tu A, Restivo J, Liu CH, Naslund JA, Patel V, Choi KW, Smoller JW. Patterns and correlates of mental healthcare utilization during the COVID-19 pandemic among individuals with pre-existing mental disorder. PLoS One 2024; 19:e0303079. [PMID: 38833458 PMCID: PMC11149861 DOI: 10.1371/journal.pone.0303079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/19/2024] [Indexed: 06/06/2024] Open
Abstract
How did mental healthcare utilization change during the COVID-19 pandemic period among individuals with pre-existing mental disorder? Understanding utilization patterns of these at-risk individuals and identifying those most likely to exhibit increased utilization could improve patient stratification and efficient delivery of mental health services. This study leveraged large-scale electronic health record (EHR) data to describe mental healthcare utilization patterns among individuals with pre-existing mental disorder before and during the COVID-19 pandemic and identify correlates of high mental healthcare utilization. Using EHR data from a large healthcare system in Massachusetts, we identified three "pre-existing mental disorder" groups (PMD) based on having a documented mental disorder diagnosis within the 6 months prior to the March 2020 lockdown, related to: (1) stress-related disorders (e.g., depression, anxiety) (N = 115,849), (2) serious mental illness (e.g., schizophrenia, bipolar disorders) (N = 11,530), or (3) compulsive behavior disorders (e.g., eating disorder, OCD) (N = 5,893). We also identified a "historical comparison" group (HC) for each PMD (N = 113,604, 11,758, and 5,387, respectively) from the previous year (2019). We assessed the monthly number of mental healthcare visits from March 13 to December 31 for PMDs in 2020 and HCs in 2019. Phenome-wide association analyses (PheWAS) were used to identify clinical correlates of high mental healthcare utilization. We found the overall number of mental healthcare visits per patient during the pandemic period in 2020 was 10-12% higher than in 2019. The majority of increased visits was driven by a subset of high mental healthcare utilizers (top decile). PheWAS results indicated that correlates of high utilization (prior mental disorders, chronic pain, insomnia, viral hepatitis C, etc.) were largely similar before and during the pandemic, though several conditions (e.g., back pain) were associated with high utilization only during the pandemic. Limitations included that we were not able to examine other risk factors previously shown to influence mental health during the pandemic (e.g., social support, discrimination) due to lack of social determinants of health information in EHR data. Mental healthcare utilization among patients with pre-existing mental disorder increased overall during the pandemic, likely due to expanded access to telemedicine. Given that clinical correlates of high mental healthcare utilization in a major hospital system were largely similar before and during the COVID-19 pandemic, resource stratification based on known risk factor profiles may aid hospitals in responding to heightened mental healthcare needs during a pandemic.
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Affiliation(s)
- Hyunjoon Lee
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Chris J. Kennedy
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Allison Tu
- Harvard College, Cambridge, Massachusetts, United States of America
| | - Juliana Restivo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cindy H. Liu
- Departments of Pediatrics and Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Karmel W. Choi
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Center for Precision Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Li G, Hu L, Gu X, Zhu W, Zhen X, Sun X. Targeting Large-Conductance Calcium-Activated Potassium Channels to Ameliorate Lipopolysaccharide-Induced Depressive-Like Behavior in Mice. Neurochem Res 2024; 49:1239-1253. [PMID: 38383879 DOI: 10.1007/s11064-024-04111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/23/2024]
Abstract
Neuroinflammation plays crucial role in the development and progression of depression. Large conductance calcium- and voltage-dependent potassium (BK) channels mediate the activation of microglia. Herein, we investigated whether BK channels could serve as a target for the treatment of inflammation-associated depression. Lipopolysaccharide (LPS, 0.83 mg/kg) was injected intraperitoneally (i.p.) to induce neuroinflammation and depressive-like behavior in 6-8 week ICR mice. Adeno-associated virus (AAV) constructs (AAV9-Iba1p-BK shRNA-EGFP (BK shRNA-AAV) or AAV9-Iba1p-NC shRNA-EGFP (NC shRNA-AAV)) were unilaterally injected intracerebroventricularly to selectively knock down BK channels in microglia. The tail suspension test (TST) and forced-swim test (FST) were used to evaluate depressive-like behavior in mice 24 h after LPS challenge. The morphology of microglia, expression of BK channels, levels of cytokines, and expression and activity of indoleamine 2,3-dioxygenase (IDO) were measured by immunohistochemistry, western blot, quantitative real time PCR, and enzyme-linked immunosorbent assay (ELISA), respectively. Either paxilline (i.p.), a specific BK channel blocker, or BK shRNA-AAV effectively inhibited the activation of microglia, reduced the production of IL-1β in the hippocampus and suppressed the expression and activity of IDO in the hippocampus and prefrontal cortex, resulting in the amelioration of depressive-like behavior in mice. These data suggest for the first time that BK channels are involved in LPS-induced depressive-like behaviors. Thus, microglia BK channels may be a potential drug target for the depression treatment.
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Affiliation(s)
- Gangjing Li
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, 199 Ren'ai Road, Suzhou, 215123, Jiangsu, China
| | - Li Hu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, 199 Ren'ai Road, Suzhou, 215123, Jiangsu, China
| | - Xiangcheng Gu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, 199 Ren'ai Road, Suzhou, 215123, Jiangsu, China
| | - Weijun Zhu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, 199 Ren'ai Road, Suzhou, 215123, Jiangsu, China
| | - Xuechu Zhen
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, 199 Ren'ai Road, Suzhou, 215123, Jiangsu, China
| | - Xiaohui Sun
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and College of Pharmaceutical Sciences, Soochow University, 199 Ren'ai Road, Suzhou, 215123, Jiangsu, China.
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Farinha-Ferreira M, Magalhães DM, Neuparth-Sottomayor M, Rafael H, Miranda-Lourenço C, Sebastião AM. Unmoving and uninflamed: Characterizing neuroinflammatory dysfunction in the Wistar-Kyoto rat model of depression. J Neurochem 2024. [PMID: 38430009 DOI: 10.1111/jnc.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/03/2024]
Abstract
Reductionistic research on depressive disorders has been hampered by the limitations of animal models. Recently, it has been hypothesized that neuroinflammation is a key player in depressive disorders. The Wistar-Kyoto (WKY) rat is an often-used animal model of depression, but no information so far exists on its neuroinflammatory profile. As such, we compared male young adult WKY rats to Wistar (WS) controls, with regard to both behavioral performance and brain levels of key neuroinflammatory markers. We first assessed anxiety- and depression-like behaviors in a battery consisting of the Elevated Plus Maze (EPM), the Novelty Suppressed Feeding (NSFT), Open Field (OFT), Social Interaction (SIT), Forced Swim (FST), Sucrose Preference (SPT), and Splash tests (ST). We found that WKY rats displayed increased NSFT feeding latency, decreased OFT center zone permanence, decreased EPM open arm permanence, decreased SIT interaction time, and increased immobility in the FST. However, WKY rats also evidenced marked hypolocomotion, which is likely to confound performance in such tests. Interestingly, WKY rats performed similarly, or even above, to WS levels in the SPT and ST, in which altered locomotion is not a significant confound. In a separate cohort, we assessed prefrontal cortex (PFC), hippocampus and amygdala levels of markers of astrocytic (GFAP, S100A10) and microglial (Iba1, CD86, Ym1) activation status, as well as of three key proinflammatory cytokines (IL-1β, IL-6, TNF-α). There were no significant differences between strains in any of these markers, in any of the regions assessed. Overall, results highlight that behavioral data obtained with WKY rats as a model of depression must be carefully interpreted, considering the marked locomotor activity deficits displayed. Furthermore, our data suggest that, despite WKY rats replicating many depression-associated neurobiological alterations, as shown by others, this is not the case for neuroinflammation-related alterations, thus representing a novel limitation of this model.
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Affiliation(s)
- Miguel Farinha-Ferreira
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Daniela M Magalhães
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mariana Neuparth-Sottomayor
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Hugo Rafael
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Miranda-Lourenço
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana M Sebastião
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Clark PJ, Valery PC, Strasser SI, Weltman M, Thompson A, Levy MT, Leggett B, Zekry A, Rong J, Sinclair M, George J, Bollipo S, McGarity B, Sievert W, MacQuillan G, Tse E, Nicoll A, Wade A, Cheng W, Roberts SK. Broadening and strengthening the health providers caring for patients with chronic hepatitis C may improve continuity of care. J Gastroenterol Hepatol 2024; 39:568-575. [PMID: 38114452 DOI: 10.1111/jgh.16440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Direct-acting antiviral (DAA) therapies for hepatitis C virus infection (HCV) lead to excellent rates of sustained virological response (SVR). However, loss to follow-up (LTFU) for SVR testing remains a challenge. We examine factors associated with LTFU in a real-world setting. METHODS Adults who received DAA therapy for HCV in one of 26 centers across Australia during 2016-2021 were followed up for 2 years. Data sources included the patient medical records and the national Pharmaceutical and Medicare Benefits Schemes. Linkage to Medicare provided utilization data of other health-care providers and re-treatment with DAAs. LTFU was defined as no clinic attendance for SVR testing by at least 52 weeks after DAA treatment commencement. Multivariable logistic regression assessed factors associated with LTFU. RESULTS In 3619 patients included in the study (mean age 52.0 years; SD = 10.5), 33.6% had cirrhosis (69.4% Child-Pugh class B/C), and 19.3% had HCV treatment prior to the DAA era. Five hundred and fifteen patients (14.2%) were LTFU. HCV treatment initiation in 2017 or later (adj-OR = 2.82, 95% confidence interval [CI] 2.25-3.54), younger age (adj-OR = 2.63, 95% CI 1.80-3.84), Indigenous identification (adj-OR = 1.99, 95% CI 1.23-3.21), current injection drug use or opioid replacement therapy (adj-OR = 1.66, 95% CI 1.25-2.20), depression treatment (adj-OR = 1.49, 95% CI 1.17-1.90), and male gender (adj-OR = 1.31, 95% CI 1.04-1.66) were associated with LTFU. CONCLUSIONS These findings stress the importance of strengthening the network of providers caring for patients with HCV. In particular, services targeting vulnerable groups of patients such as First Nations Peoples, youth health, and those with addiction and mental health disorders should be equipped to treat HCV.
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Affiliation(s)
- Paul J Clark
- Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, and Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Martin Weltman
- Hepatology Services, Nepean Hospital, Penrith, New South Wales, Australia
| | - Alex Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Miriam T Levy
- USYD, Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Barbara Leggett
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital and Faculty of Medicine, Brisbane, Queensland, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Julian Rong
- Gippsland Gastroenterology, Latrobe Regional Hospital, Traralgon, Victoria, 3844, Australia
| | - Marie Sinclair
- Department of Gastroenterology and Hepatology, Austin Hospital, Melbourne, Victoria, Australia
| | - Jacob George
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Storr Liver Unit, Westmead Hospital, Westmead, New South Wales, Australia
| | - Steven Bollipo
- Gastroenterology Department, John Hunter Hospital, New Lambton, New South Wales, Australia
- Gastroenterology Department, John Hunter Hospital, Newcastle and School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Bruce McGarity
- Bathurst Liver Clinic Bathurst Hospital, Bathurst, New South Wales, Australia
| | - William Sievert
- Gastrointestinal and Liver Unit, Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Gerry MacQuillan
- Department of Hepatology and Liver Transplant Unit, Sir Charles Gairdner Hospital, Nedlands, West Australia, Australia
| | - Edmund Tse
- Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Amanda Wade
- Burnet Institute, Melbourne, Victoria, Australia
- Barwon Health Liver Clinic University Hospital, Geelong, Victoria, Australia
| | - Wendy Cheng
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, West Australia, Australia
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Doyle T, Schmidt B, Scaglione S. Prevalence of depression and anxiety symptoms by liver disease etiology. Clin Liver Dis (Hoboken) 2023; 22:89-94. [PMID: 37799635 PMCID: PMC10550025 DOI: 10.1097/cld.0000000000000068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/13/2022] [Indexed: 10/07/2023] Open
Affiliation(s)
- Todd Doyle
- Department of Psychiatry, Loyola University Medical Center, Maywood, IL, USA
| | - Benjamin Schmidt
- Division of Gastroenterology and Hepatology, Saint Louis University, St. Louis, MO, USA
| | - Steve Scaglione
- Department of Hepatology, Loyola University Medical Center, Maywood, IL, USA
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Gutiérrez-Rojas L, de la Gándara Martín JJ, García Buey L, Uriz Otano JI, Mena Á, Roncero C. Patients with severe mental illness and hepatitis C virus infection benefit from new pangenotypic direct-acting antivirals: Results of a literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:382-396. [PMID: 35718017 DOI: 10.1016/j.gastrohep.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) infection is a global health problem that can results in cirrhosis, hepatocellular carcinoma and even death. HCV infection is 3-20-fold more prevalent among patients with versus without severe mental illness (SMI), such as major depressive disorder, personality disorder, bipolar disorder and schizophrenia. Treatment options for HCV were formerly based on pegylated interferon alpha, which is associated with neuropsychiatric adverse events, and this contributed to the exclusion of patients with SMI from HCV treatment, elimination programmes, and clinical trials. Moreover, the assumption of poor adherence, scant access to healthcare and the stigma and vulnerability of this population emerged as barriers and contributed to the low rates of treatment and efficacy. METHODS This paper reviews the literature published between December 2010 and December 2020 exploring the epidemiology of HCV in patients with SMI, and vice versa, the effect of HCV infection, barriers to the management of illness in these patients, and benefits of new therapeutic options with pangenotypic direct antiviral agents (DAAs). RESULTS The approval of DAAs has changed the paradigm of HCV infection treatment. DAAs have proven to be an equally efficacious and safe option that improves quality of life (QoL) in patients SMI. CONCLUSIONS Knowledge of the consequences of the HCV infection and the benefits of treatment with new pangenotypic DAAs among psychiatrists can increase screening, referral and treatment of HCV infection in patients with SMI.
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Affiliation(s)
| | | | - Luisa García Buey
- Gastroenterology Department, Liver Unit, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan I Uriz Otano
- Gastroenterology Department, Liver Unit, Complejo Hospitalario de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Álvaro Mena
- Infectious Diseases Unit, Internal Medicine Service, Clinical Virology Group, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña, Coruña, Spain
| | - Carlos Roncero
- Psychiatry Service, University of Salamanca Health Care Complex and Psychiatric Unit, School of Medicine, Institute of Biomedicine, University of Salamanca, Salamanca, Spain
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Lee DU, Ponder R, Lee KJ, Yoo A, Fan GH, Jung D, Chou H, Lee K, Hofheinz O, Urrunaga NH. The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019. Eur J Gastroenterol Hepatol 2023; 35:402-419. [PMID: 36728850 PMCID: PMC9974787 DOI: 10.1097/meg.0000000000002498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Hepatitis C virus (HCV) is a prominent liver disease that often presents with mental illness. We stratify the HCV population and review its healthcare burden on the US hospital system. METHODS The US National Inpatient Sample was used to select admissions related to HCV between 2016 and 2019. Weights were assigned to discharges, and trend analyses were performed. Strata were formed across demographics, comorbidities, psychiatric and substance use conditions, and other variables. Outcomes of interest included hospitalization incidences, mortality rates, total costs, and mean per-hospitalization costs. RESULTS From 2016 to 2019, there were improvements in mortality and hospitalization incidence for HCV, as well as a decline in aggregate costs across the majority of strata. Exceptions that showed cost growth included admissions with multiple psychiatric, stimulant use, or poly-substance use disorders, and a history of homelessness. Admissions with no psychiatric comorbidities, admissions with no substance use comorbidities, and admissions with housing and without HIV comorbidity showed decreasing total costs. Along with per-capita mean costs, admissions with comorbid opioid use, bipolar, or anxiety disorder showed significant increases. No significant trends in per-capita costs were found in admissions without mental illness diagnoses. CONCLUSIONS Most strata demonstrated decreases in hospitalization incidences and total costs surrounding HCV; however, HCV cases with mental illness diagnoses saw expenditure growth. Cost-saving mechanisms for these subgroups are warranted.
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Affiliation(s)
- David Uihwan Lee
- University of Maryland School of Medicine, Division of Gastroenterology and Hepatology, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Reid Ponder
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Ki Jung Lee
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Ashley Yoo
- University of Maryland School of Medicine, Division of Gastroenterology and Hepatology, 22 S. Greene St, Baltimore, MD 21201, USA
| | - Gregory Hongyuan Fan
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Daniel Jung
- University of Missouri–Kansas City School of Medicine, Department of Medicine, 2411 Holmes St, Kansas City, MO 64108
| | - Harrison Chou
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Keeseok Lee
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Olivia Hofheinz
- Tufts University School of Medicine, Department of Medicine, Washington St, Boston, MA 02111, USA
| | - Nathalie Helen Urrunaga
- University of Maryland School of Medicine, Division of Gastroenterology and Hepatology, 22 S. Greene St, Baltimore, MD 21201, USA
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Roncero C, Buch-Vicente B, Martín-Sánchez ÁM, Álvarez-Navares AI, Andrés-Olivera P, Gamonal-Limcaoco S, Lozano-López MT, Aguilar L, Sánchez-Casado F, García-Ullán L. Prevalence of hepatitis C virus infection in patients with chronic mental disorders: The relevance of dual disorders. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:171-177. [PMID: 35780956 DOI: 10.1016/j.gastrohep.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/15/2022] [Accepted: 06/25/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The prevalence of hepatitis C virus (HCV) infection is higher in people with psychiatric disorders compared to the general population. In addition, patients with severe mental illness are frequently affected by substance abuse, which increases the risk of blood-borne viral infections. Epidemiological studies in samples of hospitalised individuals with chronic mental disorders and dual diagnosis (DD) are lacking. The objective of this study was to investigate the prevalence of HCV infection in a sample of in-patients with severe mental illness. PATIENTS AND METHODS This was a retrospective observational study. All patients meeting selection criteria admitted to the Medium-Term Psychiatric Unit of the University of Salamanca Health Care Complex between 2007 and 2018 were included. The primary endpoint was the prevalence of HCV infection. The secondary endpoint comprised the characteristics influencing the occurrence of HCV infection in these patients. RESULTS A total of 497 admissions were included and patients' last admission data were considered for analyses (n=345). The overall prevalence of HCV infection was 3.8% and reached 14.3% among DD patients, who showed a higher prevalence than those without this condition (14.3% versus 3.1%, p=0.009). HCV RNA was detected in 6 individuals at diagnosis who received DAA treatment reaching sustained virological response. CONCLUSIONS The prevalence of HCV infection in our sample was higher than in the general population, especially among DD patients. Despite the multiple barriers to access healthcare by patients with chronic mental illness, efforts to include this population in screening and treatment are mandatory.
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Affiliation(s)
- Carlos Roncero
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain; Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain; Psychiatry Unit, School of Medicine, University of Salamanca, Calle Alfonso X El Sabio, s/n, 37007 Salamanca, Spain.
| | - Bárbara Buch-Vicente
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain; School of Psychology, University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain
| | - Ángel Manuel Martín-Sánchez
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain; Medium-Long-Term Hospitalisation Unit, Department of Psychiatry, University of Salamanca Health Care Complex, Hospital Los Montalvos, Carretera Ciudad Rodrigo, s/n, 37197 Carrascal de Barregas, Salamanca, Spain
| | - Ana Isabel Álvarez-Navares
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain; Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain; Psychiatry Unit, School of Medicine, University of Salamanca, Calle Alfonso X El Sabio, s/n, 37007 Salamanca, Spain; Addiction and Dual Disorders Unit, Department of Psychiatry, University of Salamanca Health Care Complex, Hospital Los Montalvos, Carretera Ciudad Rodrigo, s/n, 37197 Carrascal de Barregas, Salamanca, Spain
| | - Pilar Andrés-Olivera
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain; Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain; Psychiatry Unit, School of Medicine, University of Salamanca, Calle Alfonso X El Sabio, s/n, 37007 Salamanca, Spain
| | - Sinta Gamonal-Limcaoco
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - María Teresa Lozano-López
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Lourdes Aguilar
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain; Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain; Psychiatry Unit, School of Medicine, University of Salamanca, Calle Alfonso X El Sabio, s/n, 37007 Salamanca, Spain; Addiction and Dual Disorders Unit, Department of Psychiatry, University of Salamanca Health Care Complex, Hospital Los Montalvos, Carretera Ciudad Rodrigo, s/n, 37197 Carrascal de Barregas, Salamanca, Spain
| | - Felisa Sánchez-Casado
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain; School of Psychology, University of Salamanca, Avenida de la Merced, 109, 37005 Salamanca, Spain
| | - Llanyra García-Ullán
- Department of Psychiatry, University of Salamanca Health Care Complex, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain; Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain; Psychiatry Unit, School of Medicine, University of Salamanca, Calle Alfonso X El Sabio, s/n, 37007 Salamanca, Spain; Medium-Long-Term Hospitalisation Unit, Department of Psychiatry, University of Salamanca Health Care Complex, Hospital Los Montalvos, Carretera Ciudad Rodrigo, s/n, 37197 Carrascal de Barregas, Salamanca, Spain
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10
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Camarata MA, Ala A, Coskun AK, Deng Y, Embel VK, Gonzalez-Peralta R, Maciejewski KR, Patel A, Rubman S, To U, Tomlin R, Schilsky ML, Zimbrean PC. Major Depressive Disorder in an International Multisite Wilson Disease Registry. J Acad Consult Liaison Psychiatry 2023; 64:106-117. [PMID: 36521682 DOI: 10.1016/j.jaclp.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/13/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Psychiatric symptoms are frequently reported in Wilson disease (WD); however, systematic assessments with validated measures are lacking. OBJECTIVE We aim to report the prevalence and clinical correlates for major depressive disorder (MDD) as resulting from a multisite international WD registry. METHODS All patients enrolled in the WD registry received structured psychiatric evaluations (Mini International Neuropsychiatric Interview, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, Perceived Stress Scale), laboratory tests, hepatology, and neurological assessments. We present the analysis of the data collected at enrollment for the first 3 years (N = 62). RESULTS Thirty-seven percent (23) had a lifetime history (MDD), and 6% (4) met the criteria for an active major depressive episode. Depression was self-reported in 30.51% (19) at WD diagnosis. Patients with MDD had worse mental health quality-of-life (QOL) scores (median 43 vs 53.6, P = 0.006), higher severe anxiety (13.04% vs 0), higher perceived stress (median 18 vs 9, P < 0.003), and higher levels of neuroticism (median 8 vs 5.0, P = 0.002). We found no significant difference in physical health QOL and severity of neurological or liver disease. There was no significant difference in copper parameters or liver tests in those with MDD and without. The limitations of our study consist of the small sample size, the cross-sectional report, and the lack of brain copper measurements. CONCLUSIONS Lifetime MDD is highly prevalent in WD and associated with worse mental health QOL. We did not find a significant association among liver disease, neurological disease laboratory tests, and MDD. Screening for depression should be considered in patients with WD.
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Affiliation(s)
- Michelle A Camarata
- Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT; Gastroenterology and Hepatology, Royal Surrey County Hospital, Surrey, United Kingdom
| | - Aftab Ala
- Gastroenterology and Hepatology, Royal Surrey County Hospital, Surrey, United Kingdom; Department of Clinical and Experimental Medicine, University of Surrey, Surrey, United Kingdom; King's College Hospital, Institute of Liver Studies, London, United Kingdom
| | - Ayse K Coskun
- Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale University, New Haven, CT
| | - Veysel K Embel
- Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT
| | | | | | - Amar Patel
- Neurology, Yale University, New Haven, CT
| | | | - Uyen To
- Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT
| | - Ricarda Tomlin
- Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT
| | - Michael L Schilsky
- Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT
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11
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Is depression the missing link between inflammatory mediators and cancer? Pharmacol Ther 2022; 240:108293. [PMID: 36216210 DOI: 10.1016/j.pharmthera.2022.108293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
Patients with cancer are at greater risk of developing depression in comparison to the general population and this is associated with serious adverse effects, such as poorer quality of life, worse prognosis and higher mortality. Although the relationship between depression and cancer is now well established, a common underlying pathophysiological mechanism between the two conditions is yet to be elucidated. Existing theories of depression, based on monoamine neurotransmitter system dysfunction, are insufficient as explanations of the disorder. Recent advances have implicated neuroinflammatory mechanisms in the etiology of depression and it has been demonstrated that inflammation at a peripheral level may be mirrored centrally in astrocytes and microglia serving to promote chronic levels of inflammation in the brain. Three major routes to depression in cancer in which proinflammatory mediators are implicated, seem likely. Activation of the kynurenine pathway involving cytokines, increases tryptophan catabolism, resulting in diminished levels of serotonin which is widely acknowledged as being the hallmark of depression. It also results in neurotoxic effects on brain regions thought to be involved in the evolution of major depression. Proinflammatory mediators also play a crucial role in impairing regulatory glucocorticoid mediated feedback of the hypothalamic-pituitary-adrenal axis, which is activated by stress and considered to be involved in both depression and cancer. The third route is via the glutamatergic pathway, whereby glutamate excitotoxicity may lead to depression associated with cancer. A better understanding of the mechanisms underlying these dysregulated and other newly emerging pathways may provide a rationale for therapeutic targeting, serving to improve the care of cancer patients.
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12
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Wedemeyer H, Di Marco V, Garcia-Retortillo M, Teti E, Fraser C, Morano Amado LE, Rodriguez-Tajes S, Acosta-López S, O’Loan J, Milella M, Buti M, Guerra-Veloz MF, Ramji A, Fenech M, Martins A, Borgia SM, Vanstraelen K, Mertens M, Hernández C, Ntalla I, Ramroth H, Milligan S. Global Real-World Evidence of Sofosbuvir/Velpatasvir as a Highly Effective Treatment and Elimination Tool in People with Hepatitis C Infection Experiencing Mental Health Disorders. Viruses 2022; 14:v14112493. [PMID: 36423102 PMCID: PMC9695390 DOI: 10.3390/v14112493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Hepatitis C virus (HCV) is prevalent in people with mental health disorders, a priority population to diagnose and cure in order to achieve HCV elimination. This integrated analysis pooled data from 20 cohorts in seven countries to evaluate the real-world effectiveness of the pangenotypic direct-acting antiviral (DAA) sofosbuvir/velpatasvir (SOF/VEL) in people with mental health disorders. HCV-infected patients diagnosed with mental health disorders who were treated with SOF/VEL for 12 weeks without ribavirin as part of routine clinical practice were included. The primary outcome was sustained virological response (SVR) in the effectiveness population (EP), defined as patients with an available SVR assessment. Secondary outcomes were reasons for not achieving SVR, characteristics of patients with non-virological failures, adherence, and time from HCV RNA diagnosis to SOF/VEL treatment initiation. A total of 1209 patients were included; 142 did not achieve an SVR for non-virological reasons (n = 112; 83 lost to follow-up, 20 early treatment discontinuations) or unknown reasons (n = 30). Of the 1067 patients in the EP, 97.4% achieved SVR. SVR rates in the EP were ≥95% when stratified by type of mental health disorder and other complicating baseline characteristics, including active injection drug use and antipsychotic drug use. Of 461 patients with data available in the EP, only 2% had an adherence level < 90% and 1% had an adherence level < 80%; all achieved SVR. Patients with mental health disorders can be cured of HCV using a well-tolerated, pangenotypic, protease inhibitor-free SOF/VEL regimen. This DAA allows the implementation of a simple treatment algorithm, with minimal monitoring requirements and fewer interactions with central nervous system drugs compared with protease-inhibitor DAA regimens.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, OE6810, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-3305
| | - Vito Di Marco
- University of Palermo, Piazza Marina, 61, 90133 Palermo, Italy
| | - Montserrat Garcia-Retortillo
- Liver Section, Gastroenterology Department, Hospital del Mar-Parc de Salut Mar, Hospital del Mar Medical Research Institute (IMIM), C/ del Dr. Aiguader, 88, 08003 Barcelona, Spain
| | | | - Chris Fraser
- Cool Aid Community Health Centre, 713 Johnson St, Victoria, BC V8W 1M8, Canada
| | - Luis Enrique Morano Amado
- Unit of Infectious Diseases, Álvaro Cunqueiro University Hospital, Estrada de Clara Campoamor, 341, 36312 Vigo, Spain
| | - Sergio Rodriguez-Tajes
- Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Silvia Acosta-López
- Digestive Diseases, Hospital Nuestra Señora de Candelaria, Ctra. Gral. del Rosario, 145, 38010 Tenerife, Spain
| | - Joss O’Loan
- Medeco Inala & Kombi Clinic, 55b/156 Inala Ave, Brisbane, QLD 4077, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, Piazza Umberto I, 1, 70121 Bari, Italy
| | - Maria Buti
- Liver Unit, Vall d’Hebron University Hospital, and CIBEREHD del Instituto Carlos III, Barcelona, Spain
| | - María Fernanda Guerra-Veloz
- Virgen Macarena University Hospital, Av. Dr. Fedriani, 3, 41003 Seville, Spain
- Clinical Research Fellow in Hepatology at King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Alnoor Ramji
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Mary Fenech
- Queensland Injectors Health Network (QuIHN), Treatment and Management Programme, 1 Hamilton Pl, Bowen Hills, Brisbane, QLD 4006, Australia
| | - Alexandra Martins
- Hospital Prof. Dr. Fernando Fonseca, IC19, 2720-276 Amadora, Portugal
| | - Sergio M. Borgia
- Infectious Diseases, William Osler Health System, 2100 Bovaird Dr E, Brampton, ON L6R 3J7, Canada
| | - Kim Vanstraelen
- Gilead Sciences Europe Ltd., Stockley Park, 2 Roundwood Ave, Hayes, Uxbridge UB11 1AS, UK
| | - Michael Mertens
- Gilead Sciences Europe Ltd., Stockley Park, 2 Roundwood Ave, Hayes, Uxbridge UB11 1AS, UK
| | - Cándido Hernández
- Gilead Sciences Europe Ltd., Stockley Park, 2 Roundwood Ave, Hayes, Uxbridge UB11 1AS, UK
| | - Ioanna Ntalla
- Gilead Sciences Europe Ltd., Stockley Park, 2 Roundwood Ave, Hayes, Uxbridge UB11 1AS, UK
| | - Heribert Ramroth
- Gilead Sciences Europe Ltd., Stockley Park, 2 Roundwood Ave, Hayes, Uxbridge UB11 1AS, UK
| | - Scott Milligan
- Trio Health Analytics, 1025 Cannon Street, Suite 2C, Louisville, CO 80027, USA
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13
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Smith CM, Kennedy JL, Evans ME, Person MK, Haverkate R, Apostolou A. Mental Illness in Adults With HIV and HCV Infection: Indian Health Service, 2001-2020. Am J Prev Med 2022; 63:e77-e86. [PMID: 35589441 PMCID: PMC9887638 DOI: 10.1016/j.amepre.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mental health disorders (MHDs) and substance use disorders (SUDs) in people living with HIV, hepatitis C virus (HCV) infection, and HIV/HCV coinfection are common and result in significant morbidity. However, there are no national prevalence estimates of these comorbidities in American Indian and Alaska Native (AI/AN) adults with HIV, HCV infection, or HIV/HCV coinfection. This study estimates the prevalence of MHD and SUD diagnoses in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection within the Indian Health Service (IHS). METHODS In 2021, a cross-sectional study using data from the National Patient Information Reporting System was completed to identify MHD or SUD diagnoses in AI/AN adults with HIV, HCV infection, or HIV/HCV coinfection within the IHS during fiscal years 2001‒2020. Logistic regression was used to compare the odds of MHD or SUD diagnoses, adjusting for age and sex. RESULTS Of AI/AN adults diagnosed with HIV, hepatitis C virus infection, or HIV/HCV coinfection, the period prevalence of MHD or SUD diagnoses ranged from 57.2% to 81.1%. Adjusting for age and sex, individuals with HCV infection had higher odds of receiving a MHD diagnosis (AOR=1.57; 95% CI=1.47, 1.68) or SUD diagnosis (AOR=3.40; 95% CI=3.18, 3.65) than those with HIV, and individuals with HIV/HCV coinfection had higher odds of receiving a MHD diagnosis (AOR=1.60; 95% CI=1.35, 1.89) or SUD diagnosis (AOR=2.81; 95% CI=2.32, 3.41) than those with HIV. CONCLUSIONS MHD and SUD diagnoses were common in AI/AN adults diagnosed with HIV, HCV infection, or HIV/HCV coinfection, highlighting the need for culturally appropriate screening and treatment programs sensitive to the diverse strengths of AI/AN populations and structural challenges they endure.
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Affiliation(s)
- Colin M Smith
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Indian Health Service, Rockville, Maryland.
| | - Jordan L Kennedy
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E Evans
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marissa K Person
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Danilescu CM, Ionescu M, Sandulescu DL, Pirlog MC, Streba CT, Rogoveanu I. Perceived Stress in Hepatitis C Virus Infected Patients under the DAA-Based Therapy. Diagnostics (Basel) 2022; 12:diagnostics12051177. [PMID: 35626332 PMCID: PMC9139880 DOI: 10.3390/diagnostics12051177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 02/06/2023] Open
Abstract
The Hepatitis C Virus (HCV) infection often associates medical and mental health conditions which lead to increased levels of distress. Our study aimed at assessing the level of perceived stress on a sample of 90 HCV infected patients treated with Direct-Acting Antiviral (DAA) agents for 12 weeks, and its possible correlations with clinical and evolutionary elements. The evaluation was conducted in three phases: before administration of the DAAs (BSL), at the End of the Treatment (EOT), and 24 weeks after the BSL (Sustained Viral Response—SVR). The perceived stress was measured using the Perceived Stress Scale (PSS). The efficiency of the DAA treatment reduced the levels of stress (98.99% moderate and high stress at BSL to 70.00% at SVR). It was observed, for the entire study period (BSL to SVR), that the decrease in the perceived stress severity was significantly associated with demographic items such as gender (p < 0.01), urban environment (p < 0.001), the age of the subjects (p < 0.05), and clinical data such as F4 degree of fibrosis (p = 0.001) and overweight or obesity class II (p < 0.01). The perceived stress is directly associated with the severity of the HCV infection, and it could be significantly lowered by an efficient therapeutic approach, as DAAs are nowadays.
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Affiliation(s)
| | - Mihaela Ionescu
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Daniela Larisa Sandulescu
- Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Correspondence: (D.L.S.); (M.C.P.); Tel.: +40-251-522458 (M.C.P.)
| | - Mihail Cristian Pirlog
- Department of Medical Sociology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: (D.L.S.); (M.C.P.); Tel.: +40-251-522458 (M.C.P.)
| | - Costin Teodor Streba
- Department of Scientific Research Methodology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ion Rogoveanu
- Department of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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15
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Kronsten VT, Tranah TH, Pariante C, Shawcross DL. Gut-derived systemic inflammation as a driver of depression in chronic liver disease. J Hepatol 2022; 76:665-680. [PMID: 34800610 DOI: 10.1016/j.jhep.2021.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023]
Abstract
Depression and chronic liver disease (CLD) are important causes of disability, morbidity and mortality worldwide and their prevalence continues to rise. The rate of depression in CLD is high compared to that of the general population and is comparable to the increased rates observed in other medical comorbidities and chronic inflammatory conditions. Notably, a comorbid diagnosis of depression has a detrimental effect on outcomes in cirrhosis. Systemic inflammation is pivotal in cirrhosis-associated immune dysfunction - a phenomenon present in advanced CLD (cirrhosis) and implicated in the development of complications, organ failure, disease progression, increased infection rates and poor outcome. The presence of systemic inflammation is also well-documented in a cohort of patients with depression; peripheral cytokine signals can result in neuroinflammation, behavioural change and depressive symptoms via neural mechanisms, cerebral endothelial cell and circumventricular organ signalling, and peripheral immune cell-to-brain signalling. Gut dysbiosis has been observed in both patients with cirrhosis and depression. It leads to intestinal barrier dysfunction resulting in increased bacterial translocation, in turn activating circulating immune cells, leading to cytokine production and systemic inflammation. A perturbed gut-liver-brain axis may therefore explain the high rates of depression in patients with cirrhosis. The underlying mechanisms explaining the critical relationship between depression and cirrhosis remain to be fully elucidated. Several other psychosocial and biological factors are likely to be involved, and therefore the cause is probably multifactorial. However, the role of the dysfunctional gut-liver-brain axis as a driver of gut-derived systemic inflammation requires further exploration and consideration as a target for the treatment of depression in patients with cirrhosis.
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Affiliation(s)
- Victoria T Kronsten
- Institute of Liver Studies, 1(st) Floor James Black Centre, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK.
| | - Thomas H Tranah
- Institute of Liver Studies, 1(st) Floor James Black Centre, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK
| | - Carmine Pariante
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RT, UK
| | - Debbie L Shawcross
- Institute of Liver Studies, 1(st) Floor James Black Centre, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 125 Coldharbour Lane, London, SE5 9NU, UK
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16
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Abstract
BACKGROUND Recent studies have suggested that microglial activation plays a key role in the pathogenesis of depression. In fact, neuroinflammation is associated with a phenotypic change of microglia, consisting of morphological differences, increased release of cytokines and oxidative stress products, which may contribute to the development and maintenance of depression. Antidepressants, including selective serotonin re-uptake inhibitors and serotonin-norepinephrine reuptake inhibitors, have been shown to act on the immune and oxidative stress mechanisms commonly found to be disrupted in depression. Thus, the inhibition of microglial activation may be one of the mechanisms through which they exert an antidepressant action. AIM This is the first review summarising in vitro and ex vivo studies investigating the effects of different classes of antidepressants on microglia activation, by examining cellular changes and/or via measuring the production of immune and/or oxidative stress signalling molecules, in microglia models of neuroinflammation with either lipopolysaccharide (LPS) or cytokines. A total of 23 studies were identified, 18 using LPS stimulation and 5 using cytokines stimulation. RESULTS Overall, the studies show that antidepressants, such as selective serotonin re-uptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and tricyclic antidepressants prevented microglial activation, including reduced microglial reactivity and decreased immune and oxidative stress products, in both models. However, specific antidepressants, such as bupropion and agomelatine did not prevent interferon-gamma (IFN-γ)-induced microglial activation; and for other antidepressants, including phenelzine, venlafaxine and sertraline, the results of different studies were inconsistent. CONCLUSIONS Overall, results summarised in this review support the hypothesis that the action of at least certain classes of antidepressants may involve regulation of microglial activation, especially when in presence of increased levels of inflammation.
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Affiliation(s)
- Nicole Mariani
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - James Everson
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alessandra Borsini
- Stress, Psychiatry and Immunology Laboratory, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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17
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Khuhro Q, Shaikh H, Washdev, Hashmi S. Depression trends in Hepatitis-C PCR positive and PCR negative patients. Pak J Med Sci 2022; 38:162-166. [PMID: 35035419 PMCID: PMC8713198 DOI: 10.12669/pjms.38.1.4788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 08/28/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the frequency of depression in Hepatitis-C patients and its association clearance of HCV Methods: It is cross sectional study that was conducted between 1st July to 31st December, 2020, at National Institute of Liver and Gastrointestinal Diseases (NILGID),, Dow University of Health Sciences (DUHS).. Both male and female patients aged 18 to 60 years presenting with Hepatitis-C PCR positive or had received DAA for three months and became PCR negative were included in this cross sectional study. Depression was analyzed by Hamilton Depression Rating Scale (HDRS). Mean and standard deviations were calculated and analyzed. Results: Total 210 patients were included in this study, with mean age 36.06 ± 10.11 years. Depression was present in 118 (56.2%) patients. Among patients with HCV PCR positive depression present in 63 (30.0%) patients while in HCV PCR negative 55 (26.0%) patients. Similarly, depression in HCV PCR positive male patients, aged ≤40 years 80 (38.1%) and in HCV PCR negative 56 (26.7%) patients. Conclusion: Patients with chronic Hepatitis-C commonly suffer from depression. However, our study found no significant difference with change in PCR status at 12 weeks.
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Affiliation(s)
- Qutabuddin Khuhro
- Qutabuddin Khuhro, National Institute of Gastrointestinal Disease, Dow University Hospital, DUHS, Ojha Campus, Karachi, Pakistan
| | - Hafeezullah Shaikh
- Hafeezullah Shaikh, National Institute of Gastrointestinal Disease, Dow University Hospital, DUHS, Ojha Campus, Karachi, Pakistan
| | - Washdev
- Washdev, Institute of Behavioral Sciences, DUHS, Karachi, Pakistan
| | - Shahkamal Hashmi
- Shahkamal Hashmi, School of Public Health, DUHS, Karachi, Pakistan
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18
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Iglesias-González M, Boigues M, Sanagustin D, Giralt-López M, Cuevas-Esteban J, Martínez-Cáceres E, Díez-Quevedo C. Association of serum interleukin-6 and C-reactive protein with depressive and adjustment disorders in COVID-19 inpatients. Brain Behav Immun Health 2021; 19:100405. [PMID: 34927104 PMCID: PMC8664764 DOI: 10.1016/j.bbih.2021.100405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background Immune mechanisms are part of the pathophysiology of mental disorders, although their role remains controversial. In depressive disorders a chronic low-grade inflammatory process is observed, with higher interleukin-6 (IL-6) values. Furthermore, in SARS-CoV2 infection, which is closely related to depressive disorders, there is a proinflammatory cascade of cytokines that causes systemic inflammation. Methods The present study evaluates the relationship between IL-6 and C-reactive protein (CRP) serum levels and the presence of depressive and adjustment disorders in a sample of 1851 patients admitted to hospital for SARS-CoV2 infection from March to November 2020. Concentrations of IL-6 and CRP were determined within the first 72 h at admission and compared among groups of patients according to previous history and current presence of depression or adjustment disorders. Results IL-6 serum levels were significantly higher in the group of patients with depression and adjustment disorders compared to patients without such disorders (114.25 pg/mL (SD, 225.44) vs. 86.41 (SD, 202.97)), even after adjusting for several confounders. Similar results were obtained for CRP (103.94 mg/L (SD, 91.16) vs. 90.14 (SD, 85.73)). The absolute levels of IL-6 and CRP were higher than those of previous depression studies, and differences were only found for the subgroup of De Novo depressive or adjustment disorders. Conclusions Serum concentrations of IL-6 and CRP are higher in COVID-19 patients with De Novo but not persistent depressive or adjustment disorders. Clinical features such as fatigue, asthenia, anhedonia, or anxiety can be the basis for this finding. Inflammation markers are higher in COVID inpatients with affective symptoms and no previous psychiatric history. Sickness behavior overlaps with stress-related disorders symptomatology. Cytokine levels equalize in non-depressed and chronically depressed COVID inpatients. COVID inpatients with affective symptoms may show a worse prognosis.
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Affiliation(s)
- Maria Iglesias-González
- Psychiatry Service, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Marc Boigues
- Division of Immunology, LCMN. Germans Trias i Pujol University Hospital and Research Institute, Campus Can Ruti, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Sanagustin
- Psychiatry Service, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Giralt-López
- Psychiatry Service, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jorge Cuevas-Esteban
- Psychiatry Service, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Eva Martínez-Cáceres
- Division of Immunology, LCMN. Germans Trias i Pujol University Hospital and Research Institute, Campus Can Ruti, Badalona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Crisanto Díez-Quevedo
- Psychiatry Service, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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19
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Cunha LRD, Castro MCMD, Duarte GS, Nascimento GCE, Rocha GA, Silva LD. MAJOR DEPRESSIVE DISORDER IS ASSOCIATED WITH TYPE 2 DIABETES IN PATIENTS WITH CHRONIC HEPATITIS C INFECTION. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:476-482. [PMID: 34909853 DOI: 10.1590/s0004-2803.202100000-86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is commonly reported in patients with chronic hepatitis C (CHC); however, the factors behind the co-occurrence of these conditions have not been completely clarified yet. OBJECTIVE We aimed to evaluate the frequency of mental disorders in CHC patients and to investigate variables associated with MDD. METHODS CHC patients (n=151) attending a referral Centre for hepatitis were evaluated using the Mini-International Neuropsychiatry Interview and the Cut-Annoyed-Guilty-Eye (CAGE) Questionnaire. Multivariate analysis was used to evaluate independent covariates associated with current MDD. RESULTS Seventy-six (50.3%) patients had, at least, one current psychiatric diagnosis with MDD (33.1%) being the most common. Current MDD was independently associated with age (≤50 yr.) (OR=2.57; 95%CI=1.25-5.29; P=0.01) and type 2 diabetes mellitus (OR=2.80, 95%CI=1.17-6.70; P=0.02). Cirrhosis was associated with type 2 diabetes mellitus (OR=5.09; 95%CI=1.73-15.04; P=0.03) and current alcohol abuse/dependence (OR=2.54; 95%CI=1.04-6.22; P=0.04). DISCUSSION MDD is associated with type 2 diabetes in CHC patients. Even in the direct-acting antivirals (DAAs) era, characterized by great perspectives for the first ample cure of a chronic viral infection, we should ensure that the screening for psychiatric disorders takes place in the course of routine clinical care of patients chronically infected with hepatitis C virus.
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Affiliation(s)
- Luciana Rodrigues da Cunha
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Ambulatório de Hepatites Virais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Programa de Pós-Graduação em Neurociências, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brasil
| | - Maria Carolina Magalhães de Castro
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Ambulatório de Hepatites Virais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil
| | - Gabriela Silva Duarte
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Ambulatório de Hepatites Virais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil
| | - Graziela Cançado E Nascimento
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Ambulatório de Hepatites Virais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil
| | - Gifone Aguiar Rocha
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório de Pesquisa em Bacteriologia, Belo Horizonte, MG, Brasil
| | - Luciana Diniz Silva
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Ambulatório de Hepatites Virais, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Clínica Médica, Belo Horizonte, MG, Brasil
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20
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Qin Z, Shen Y, Wu Y, Tang H, Zhang L. Analysis of risk factors for mental health problems of inpatients with chronic liver disease and nursing strategies: A single center descriptive study. Brain Behav 2021; 11:e2406. [PMID: 34766467 PMCID: PMC8671788 DOI: 10.1002/brb3.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/10/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
The number of patients with chronic liver disease (CLD) is large. The social and economic burdens due to CLD have increased. The mental health problems of patients with CLD are prominent and deserve our attention and care. This study analyzed 320 patients with CLD who were hospitalized between January 2018 and January 2020. Questionnaire surveys were used to assess mental health status, including the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Symptom Checklist-90 (SCL-90). At the same time, basic data and potential related factors were collected. Data were analyzed using descriptive statistics and logistic regression. Among the 320 patients with CLD, 240 (75%) had mental health problems; among the total patients, education levels, occupations, course of disease, annual hospitalizations, complications, and nursing satisfaction were significantly different between the two groups (p < .05). The education levels and occupations of the group without mental health problems were significantly different within the group (p < .05). The SCL-90 found that the four factors with the highest scores were anxiety (ANX: 33.3%), depression (DEPR: 20.4%), somatization (SOM: 12.9%), and sleep and diet (SD: 9.6%). Logistic regression analysis showed that education levels, course of disease, annual hospitalizations, complications, and nursing satisfaction levels were independent risk factors for the mental health of patients with CLD. Model fitness was checked using the Hosmer-Lemeshow test. The receiver operating characteristic (ROC) curve showed that the area under the curve was 0.84. Patients with CLD have prominent mental health problems and experience many risk factors. It is necessary to adopt individualized psychological interventions and care to improve the quality of life of these patients.
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Affiliation(s)
- Zhu Qin
- Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yannan Shen
- Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuanhao Wu
- Department of Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Haicheng Tang
- Department of Critical Care Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lin Zhang
- Department of Nursing, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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21
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Rafique S, Khan MS, Unar R, Wajid M, Waheed A, Umar A. Evaluation of mental health and anxiety level among hepatitis C patients during COVID-19 pandemic in Pakistan. EGYPTIAN LIVER JOURNAL 2021; 11:50. [PMID: 34777869 PMCID: PMC8197598 DOI: 10.1186/s43066-021-00120-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/02/2021] [Indexed: 12/28/2022] Open
Abstract
Background This study was conducted to check anxiety level and mental stress in the 200 confirmed hepatitis C patients during the COVID-19 pandemic. The Chinese version of the Beck Anxiety Inventory (BAI) score index was used to measure the anxiety level of HCV-positive patients. BAI score index of different demographic factors such as gender, age, occupation, and education of all the sampled population was calculated. Results The highest BAI score was recorded in people in the age group of 25–45 years (54.5%). Respondents from public sector employees, own businesses, and postgraduates were highly anxious. A significant difference in BAI score was also recorded between male and female respondents as 33.77% of females were at a severe level of anxiety compared to 17.07% of males. Furthermore, quarantined hepatitis C patients had a significantly higher BAI score (39.5) as compared to non-quarantined patients (27.12), and respondents with HCV infection also had a high BAI score of 37.25 compared to healthy individuals (4.1). Most of the respondents were willing to adopt protective measures against COVID-19. Conclusion This study concluded that people with infectious diseases like hepatitis C had high anxiety levels and mental stress in the COVID-19 pandemic and needed psychological aids for better mental health to handle pandemic conditions.
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Affiliation(s)
- Sadia Rafique
- Department of Zoology, Faculty of Life Sciences, University of Okara, Okara, 56130 Pakistan
| | - Muhammad Saleem Khan
- Department of Zoology, Faculty of Life Sciences, University of Okara, Okara, 56130 Pakistan
| | - Rabia Unar
- Jinnah Post Graduate Medical Center Hospital, Karachi, Pakistan
| | - Muhammad Wajid
- Department of Zoology, Faculty of Life Sciences, University of Okara, Okara, 56130 Pakistan
| | - Ahmad Waheed
- Department of Zoology, Faculty of Life Sciences, University of Okara, Okara, 56130 Pakistan
| | - Ali Umar
- Department of Zoology, Faculty of Life Sciences, University of Okara, Okara, 56130 Pakistan
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22
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Sleep and liver disease: a bidirectional relationship. Lancet Gastroenterol Hepatol 2021; 6:850-863. [PMID: 34273289 DOI: 10.1016/s2468-1253(21)00169-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023]
Abstract
Sleep is a complex, highly regulated process essential for human health and wellbeing. Increasingly, sleep-wake disturbance has been implicated in the pathogenesis of chronic liver disease, particularly the development and progression of non-alcoholic fatty liver disease and alcohol-related liver disease. Patients with cirrhosis also have a high burden of sleep abnormalities with substantial implications for their quality of life and physical health. This Review summarises the epidemiology and pathophysiology of sleep-wake disturbance in liver disease and discusses the multiple converging pathways leading to abnormal sleeping patterns in patients with cirrhosis. This includes contributions from altered melatonin metabolism, neuromuscular complications, and aberrant thermoregulation. In turn, a vicious cycle is established whereby disrupted sleep can further contribute to liver disease progression. We also begin to unravel the complex, interlinking relationship between sleep-wake disturbance and hepatic encephalopathy, discussing both overlapping and distinct mechanisms and clinical features. Finally, we summarise the current and future therapeutic approaches aiming to improve sleep quality in patients with cirrhosis.
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23
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Camarata MA, Ala A, Coskun AK, Deng Y, Gonzalez-Peralta RP, Maciejewski KR, Patel A, Rubman S, To U, Tomlin R, Schilsky ML, Zimbrean PC. The Effect of Mental Health, Neurological Disease, and Liver Disease on Quality of Life in Patients With Wilson Disease. J Acad Consult Liaison Psychiatry 2021; 62:528-537. [PMID: 34044196 PMCID: PMC11165927 DOI: 10.1016/j.jaclp.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/03/2021] [Accepted: 04/10/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Wilson disease (WD) is a chronic disorder of copper metabolism which may affect patient's quality of life (QOL). OBJECTIVE Our aim was to assess the relationship between mental QOL (M-QOL) and physical QOL (P-QOL) and severity of the liver, neurological disease and mental health in patients with WD. METHODS At enrollment into our multisite international WD registry, adults (n = 62) were administered examinations assessing QOL (Short-Form 12-Item Health Survey), cognition, and mood. Patients also underwent hepatology and neurological assessments. RESULTS Patients had lower M-QOL than P-QOL scores, P = 0.0006. Patients with major depressive disorder (n = 22) had worse M-QOL scores, P = 0.0017 but not P-QOL. We found no association with impaired cognition (n = 37) and QOL. The P-QOL scores have a moderate negative association with neurological disease severity based on the Unified Wilson Disease Rating Scale score (total [r = -0.38, P < 0.003], part 2 [r = -0.50, P < 0.0001], and part 3 [r = -0.37, P = 0.004]). M-QOL was not associated with Unified Wilson Disease Rating Scale scores. Worse P-QOL, but not M-QOL, was found in higher cirrhosis severity indicated by Child-Pugh (r = -0.80, P = 0.002) and Model for End Stage Liver Disease scores (r = -0.64, P = 0.03). CONCLUSIONS M-QOL was associated with depression but not cognitive impairment, neurological disease, or liver disease severity, suggesting that mental health issues may affect overall QOL independent of the degree of liver or neurological disease. P-QOL was affected by the severity of neurological and liver disease but not mental health but also contributes to overall QOL in WD. An appreciation of the range of problems that affect QOL in adults with WD will help health care providers address issues that could improve overall well-being. The Short-Form 12-Item Health Survey may provide a useful instrument for QOL surveillance in WD.
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Affiliation(s)
- Michelle A Camarata
- Yale University, Digestive Diseases, Transplantation and Immunology, New Haven, United States; Royal Surrey County Hospital, Gastroenterology and Hepatology, Guilford, United Kingdom; Department of Clinical and Experimental Medicine, University of Surrey, Guilford, United Kingdom.
| | - Aftab Ala
- Royal Surrey County Hospital, Gastroenterology and Hepatology, Guilford, United Kingdom; Department of Clinical and Experimental Medicine, University of Surrey, Guilford, United Kingdom; King's College Hospital, Institute of Liver Studies, London, United Kingdom
| | - Ayse K Coskun
- Yale University, Digestive diseases, transplantation and immunology, New Haven, United States
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale University, New Haven, United States
| | | | | | - Amar Patel
- Yale University, Neurology, New Haven, United States
| | - Susan Rubman
- Yale University, Psychiatry, New Haven, United States
| | - Uyen To
- Yale University, Digestive diseases, transplantation and immunology, New Haven, United States
| | - Ricarda Tomlin
- Yale University, Digestive diseases, transplantation and immunology, New Haven, United States
| | - Michael L Schilsky
- Yale University, Digestive diseases, transplantation and immunology, New Haven, United States
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Influence of gender on cytokine induced depression and treatment: Gender aspects of IFN-α-induced depression. J Affect Disord 2021; 292:766-772. [PMID: 34171555 DOI: 10.1016/j.jad.2021.05.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/23/2021] [Accepted: 05/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cytokine treatment with Interferon-alpha (IFN-α) represents a clinical model of immune associated depression, but it remains unclear if it is of the same entity as major depressive disorder (MDD). The study focuses on possible gender differences in IFN-α induced depression and effects of a pre-emptive antidepressant treatment. METHODS Data from 181 patients with chronic hepatitis C infection (cHC) without history of mental illnesses undergoing treatment with IFN-α 2a and ribavirin were re-analyzed for gender effects. Patients with a pre-emptive antidepressant therapy with Escitalopram (n = 90, verum group) to prevent IFN-induced depression were compared to patients who received placebo (n = 91). Depressive symptoms before and during HCV-treatment were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS), Beck's Depression Inventory (BDI) and the Hamilton Anxiety Rating Scale. RESULTS We found significant differences regarding the incidence and severity of depressive symptoms between men and women for patients without antidepressant pre-treatment (placebo group). Significantly more women without pre-emptive antidepressant therapy suffered from clinically relevant depression (MADRS values ≥ 13, p = 0.041) and self-rated depressive symptoms (BDI ≥ 17, p = 0.024). Antidepressant pre-treatment showed comparable effects regarding the reduction of incidence and severity of depression in both women and men. CONCLUSIONS Compared to MDD, IFN-alpha-induced depression in patients with cHC is also characterized by gender differences with an increased risk for women but no gender difference regarding the effects of an antidepressant pre-treatment is found. Our data strengthens the hypothesis that Interferon-induced depression serves as a clinical model for immune related depressive disorders.
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25
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Rapid improvement of psychiatric stigmata after IFN-free treatment in HCV patients with and without cryoglobulinemic vasculitis. Clin Rheumatol 2021; 41:147-157. [PMID: 34409558 PMCID: PMC8724104 DOI: 10.1007/s10067-021-05877-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 10/29/2022]
Abstract
OBJECTIVE Hepatitis C virus (HCV) causes neuropsychiatric disorders and quality of life impairment, especially in patients with cryoglobulinemic vasculitis (CV). Direct acting antivirals (DAAs) are effective in most extrahepatic HCV diseases, but limited information exists regarding the outcome of psychiatric disorders in patients with and without CV, after therapy. We aimed to evaluate psychiatric outcomes, in HCV-patients with and without CV, before and after successful DAA therapy. METHODS We prospectively studied DAA-treated HCV-patients, stratified into presence (CV) or absence of CV (NON-CV). Four psychometric scales were administered to assess depression (HAM-D and MADRS), anxiety (HAM-A), and mania (MRS). Short-Form-36 questionnaires evaluated quality of life. RESULTS Seventy-six patients were recruited, and 47 CV and 29 NON-CV were treated with antivirals. At baseline, depression and anxiety, from mild to severe, were frequently shown, with the most advanced cases in thee CV group; no patients achieved the scores for mania. A significant improvement emerged for all the psychometric scales in the entire population and in the subgroups, after viral eradication even in the short-term outcome. The Short-Form-36 summary components showed benefits. CONCLUSIONS After HCV eradication, the depression and anxiety scores significantly improved and severity grade generally lowered. DAA-positive effects on mental disorders should be considered part of the therapy outcome, being beneficial especially in CV patients who usually have worse baseline mental scores. Key Points • HCV frequently causes psychiatric disorders and an often-invalidating autoimmune/lymphoproliferative disease called cryoglobulinemic vasculitis. • The new direct acting antivirals (DAAs) are very effective and well tolerated by HCV-patients. • This study shows DAA-induced benefits on depression and anxiety in HCV-patients that are especially evident in CV patients who usually have worse baseline mental scores. • DAA-induced benefits are observed in the short-term post-therapy follow-up, in contrast with data previously obtained in HCV patients treated with IFN-based anti-HCV therapy.
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26
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Wang H, Wen B, Chang X, Wu Q, Wen W, Zhou F, Guo Y, Ji Y, Gu Y, Lai Q, He Q, Li J, Chen J, Hou J. Baveno VI criteria and spleen stiffness measurement rule out high-risk varices in virally suppressed HBV-related cirrhosis. J Hepatol 2021; 74:584-592. [PMID: 33039403 DOI: 10.1016/j.jhep.2020.09.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/29/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There are no data validating the performance of spleen stiffness measurement in ruling out high-risk varices in patients with HBV-related cirrhosis under maintained viral suppression. Thus, we aimed to prospectively validate the performance of spleen stiffness measurement (cut-off 46 kPa) combined with Baveno VI criteria in ruling out high-risk varices in these patients. METHODS Patients with cirrhosis were enrolled from April to December 2019 at the hepatology unit of the Nanfang Hospital, China. Liver and spleen transient elastography and esophagogastroduodenoscopy were performed at enrollment. Antiviral regimen(s) and virological responses, evaluated every 3-6 months, were recorded. RESULTS Overall 341 patients with HBV-related cirrhosis under maintained viral suppression were enrolled, and the prevalence of high-risk varices was 20.5% (70/341). Baveno VI criteria spared 37.0% (126/341) esophagogastroduodenoscopies and no high-risk varices were missed (0/70). Eight cases of high-risk varices (8/70, 11.4%) were misclassified in patients (208/341, 61.0%) within the expanded Baveno VI criteria. The spleen stiffness measurement cut-off (≤46.0 kPa) was shown to safely rule out high-risk varices in these patients (the percentage of missed high-risk varices was 4.3%). Over half (61.6%, 210/341) of patients met the combined model (Baveno VI criteria and spleen stiffness measurement cut-off ≤46 kPa) and 4.3% (3/70) of high-risk varices cases were misclassified. This combined model exhibited a sensitivity of 95.71%, specificity of 76.38%, negative predictive value of 98.57%, and negative likelihood ratio of 0.06 for ruling out high-risk varices. CONCLUSIONS We validated the excellent performance of Baveno VI criteria combined with spleen stiffness measurement (cut-off 46 kPa) for safely ruling out high-risk varices in patients with HBV-related cirrhosis under viral suppression; more than half of esophagogastroduodenoscopy procedures were spared using this combination. CLINICAL TRIAL NUMBER NCT04123509 LAY SUMMARY: Esophageal varices have important prognostic implications in patients with cirrhosis. Thus, their timely identification is important so that treatment can be initiated early. Herein, we validated the excellent performance of the combination of Baveno VI criteria with spleen stiffness measurement (cut-off 46 kPa) for ruling out high-risk esophageal varices in patients with HBV-related cirrhosis under maintained viral suppression (with antiviral treatment). This combined model was able to safely rule out high-risk varices (missed/total <5%) and over half (61.6%) of esophagogastroduodenoscopy procedures were spared.
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Affiliation(s)
- Haiyu Wang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Biao Wen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianyi Chang
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiaoping Wu
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weiqun Wen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fuyuan Zhou
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yabing Guo
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yali Ji
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yixiu Gu
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qintao Lai
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qinjun He
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junying Li
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinjun Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Jinlin Hou
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Risk and Protective Factors Associated with Daytime Sleepiness in Patients Diagnosed with Hepatitis B or Hepatitis C Infection. HEPATITIS MONTHLY 2021. [DOI: 10.5812/hepatmon.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: Poor sleep quality and daytime fatigue are common features of chronic hepatitis. Objectives: To evaluate the association between daytime sleepiness and hepatitis and to identify factors that contribute to daytime sleepiness in patients with hepatitis B and those with hepatitis C. Methods: In this prospective cross-sectional pilot study, outpatients with fatigue who did not receive any treatment for hepatitis were recruited from the Department of Gastroenterology and Hepatology and were classified into 5 groups of hepatitis B, hepatitis C, hepatitis B + C, other hepatitis types, and without hepatitis (controls). Gastroesophageal reflux and daytime sleepiness were determined based on two self-reported questionnaires, and linear and logistic regression analyses were performed. Results: In total 42 subjects had hepatitis B, 62 had hepatitis C, 9 had hepatitis B + C, 4 had other hepatitis types, and 14 had no hepatitis. Of them, 38 (29.01%) had gastroesophageal reflux (GERDQ score ≥ 12), and 13 (9.92%) had daytime sleepiness (ESS score ≥ 8). Hepatitis B patients with gastroesophageal reflux had significantly higher odds of daytime sleepiness [odds ratio (OR) = 12.44, 95% confidence interval (CI) = 1.59 - 261.02]. In hepatitis C patients, hypertension was significantly associated with daytime sleepiness (OR = 15.6, 95% CI = 2.13 - 143.21), while those with taller body height and elevated serum glutamic-oxaloacetic transaminase (GOT) levels had significantly lower odds of daytime sleepiness (body height: OR = 0.81, 95% CI = 0.65 - 0.93; GOT: OR = 0.76, 95% CI = 0.55 - 0.95). Conclusions: Gastroesophageal reflux is a risk factor for daytime sleepiness in hepatitis B patients. In hepatitis C patients, hypertension is a risk factor, while taller body height and elevated serum GOT are protective factors for daytime sleepiness.
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Nistal-Villán E, Argemi J, de Jaime-Soguero A, Ferrero R, di Scala M, Rodriguez-Garcia E, Coll A, Rius-Rocabert S, Prieto J, González-Aseguinolaza G, Aragón T. Linking the Expression of Therapeutic Genes to Unfolded Protein Response: A New Option for Anti-Hepatitis B Virus Gene Therapy. Hum Gene Ther 2021; 32:341-348. [PMID: 33213214 DOI: 10.1089/hum.2019.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tight control of transgene expression is key to ensure the efficacy of a wide range of gene therapy interventions, in which the magnitude and duration of gene expression have to be adjusted to therapeutic needs, thereby limiting secondary effects. The development of upgraded strategies to link transgene expression to pathological stress episodes is an unmet need in gene therapy. Here, we propose an expression strategy that associates transgene expression to an intracellular stress coping mechanism, the unfolded protein response. Specifically, we harnessed the cis elements required to sustain the noncanonical splicing of X-box binding protein 1 (XBP1) messenger RNA (mRNA) in response to the dysfunction of the endoplasmic reticulum (ER), a situation commonly known as ER stress, to drive the expression of heterologous genes. Since ER stress features a wide variety of pathological conditions, including viral infections, cancer, or metabolic disorders, this new expression module stimulates the synthesis of therapeutic genes as a response to cellular damage, and ensures their expression only when necessary. Validation of this inducible expression system was performed in vitro and in vivo, and its potential to limit/inhibit viral infections has been shown in proof-of principle experiments.
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Affiliation(s)
- Estanislao Nistal-Villán
- Microbiology Section, Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, Madrid, Spain
- Facultad de Medicina, Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, Madrid, Spain
| | - Josepmaria Argemi
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Anchel de Jaime-Soguero
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Roberto Ferrero
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marianna di Scala
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Estefania Rodriguez-Garcia
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Aniol Coll
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Sergio Rius-Rocabert
- Microbiology Section, Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, Madrid, Spain
- Facultad de Medicina, Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, Madrid, Spain
- Centre for Metabolomics and Bioanalysis (CEMBIO), Facultad de Farmacia, Universidad San Pablo-CEU, Madrid, Spain
| | - Jesús Prieto
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Gloria González-Aseguinolaza
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Tomás Aragón
- Department of Gene Therapy and Regulation of Gene Expression, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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Koffas A, Toumpanakis C. Comparative safety review of the current therapies for gastroenteropancreatic neuroendocrine tumors. Expert Opin Drug Saf 2020; 20:321-334. [PMID: 33338383 DOI: 10.1080/14740338.2021.1867097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Neuroendocrine neoplasms (NENs) comprise a heterogeneous group of neoplasms, whose management requires complex and individualized clinical decisions. Over the last decades the advent of novel medications and advanced diagnostic and therapeutic modalities, alongside our deeper understanding of the disease, revolutionized the landscape of their management, significantly improving both prognosis and quality of life of patients.Area covered: Treatment-related adverse events and safety concerns as demonstrated in clinical trials, as well as in real-world clinical practice.Expert opinion: The only true curative option for NENs remains surgery, whereas high-grade advanced neuroendocrine carcinomas should be primarily managed with platinum-based chemotherapy. For the remaining cases, that comprise the vast majority, the current armamentarium includes somatostatin analogs, interferon, telotristat ethyl, molecular targeted therapies, chemotherapy, peptide receptor radionuclide therapy, and locoregional treatment. The use of the aforementioned therapeutic options is associated with several and not uncommonly severe treatment-related adverse events. However, the benefits offered inclusive of improved prognosis, amelioration of symptoms, and better quality of life amidst others, by far outweighs any adverse event.
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Affiliation(s)
- Apostolos Koffas
- Department of Gastroenterology, General University Hospital of Larisa, Mezourlo Larisa, Greece
| | - Christos Toumpanakis
- Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK
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Dahir K, Roberts MS, Krolczyk S, Simmons JH. X-Linked Hypophosphatemia: A New Era in Management. J Endocr Soc 2020; 4:bvaa151. [PMID: 33204932 PMCID: PMC7649833 DOI: 10.1210/jendso/bvaa151] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 01/29/2023] Open
Abstract
X-linked hypophosphatemia (XLH) is a rare, hereditary, progressive musculoskeletal disease that often causes pain and short stature, as well as decreased physical function, mobility, and quality of life. Hypophosphatemia in XLH is caused by loss of function mutations in the phosphate-regulating endopeptidase homolog X-linked (PHEX) gene, resulting in excess levels of the phosphate-regulating hormone fibroblast growth factor 23 (FGF23), which leads to renal phosphate wasting and decreased serum 1,25-dihydroxyvitamin D production. Historically, treatment options were limited to oral phosphate and active vitamin D analogues (conventional management) dosed several times daily in an attempt to improve skeletal mineralization by increasing serum phosphorus. The recent approval of burosumab, a fully human monoclonal antibody to FGF23, has provided a new, targeted treatment option for patients with XLH. This review summarizes our current understanding of XLH, the safety and efficacy of conventional management and burosumab, existing recommendations for managing patients, and unanswered questions in the field.
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Affiliation(s)
- Kathryn Dahir
- Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Semmo N, Müllhaupt B, Ruckstuhl L, Magenta L, Clerc O, Torgler R, Semela D. A prospective, multicenter, post-marketing observational study to measure the quality of life of HCV genotype 1 infected, treatment naïve patients suffering from fatigue and receiving 3D regimen: The HEMATITE study. PLoS One 2020; 15:e0241267. [PMID: 33147283 PMCID: PMC7641439 DOI: 10.1371/journal.pone.0241267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/08/2020] [Indexed: 01/27/2023] Open
Abstract
Aim Fatigue is the most commonly reported symptom of Hepatitis C Virus (HCV) infected patients and severely impacts their quality of life. The aim of this study was to measure the impact of 3D regimen treatment on the fatigue, daytime physical activity and sleep efficiency of HCV infected patients with fatigue. Methods HEMATITE was an observational, prospective, open-label, single-arm, Swiss multi-centric study in mono-infected HCV genotype 1 patients. The 28 week observation period comprised of 4 weeks preparation, 12 weeks treatment and 12 weeks follow-up. Fatigue was assessed using the fatigue severity scale (FSS) questionnaire. Patients with FSS ≥ 4 (clinically significant fatigue) were included. The activity tracker, ActiGraph GT9X Link®, was used to measure daytime physical activity and sleep efficiency. Outcome analysis was performed on a scaled down intention to treat (sdITT) population, which excluded patients with insufficient tracker data at all study visits and a modified ITT (mITT) population, which consisted of patients with complete tracker data at all study visits. Results Forty of 41 patients in the ITT population had a sustained virologic response 12 weeks post-treatment (SVR12). Mean baseline FSS score was 6.0 for the sdITT population and 5.9 for the mITT population and decreased from baseline to 12 weeks post-treatment by 2.6 (95% confidence interval [CI]: 2.1, 3.1) for the sdITT (n = 37) population and 2.8 (95% CI: 2.2, 3.4) for the mITT (n = 24) population. Mean daytime physical activity or sleep efficiency did not change considerably over the course of the study. Conclusion Measurement by the activity tracker of mean day time physical activity did not show a considerable change from baseline to SVR12 upon treatment with 3D regimen. Nevertheless, a reduction of fatigue as assessed with the validated fatigue severity scale (FSS) was observed, suggesting a causative role of HCV in this extrahepatic manifestation. Trial registration ClinicalTrials.gov identifier:NCT03002818.
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Affiliation(s)
- Nasser Semmo
- Hepatology, Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Beat Müllhaupt
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | | | | | - Olivier Clerc
- Infectious Diseases Department, Hospital Pourtalès, Neuchâtel, Switzerland
| | | | - David Semela
- Division of Gastroenterology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- * E-mail:
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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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Fabrazzo M, Zampino R, Vitrone M, Sampogna G, Del Gaudio L, Nunziata D, Agnese S, Santagata A, Durante-Mangoni E, Fiorillo A. Effects of Direct-Acting Antiviral Agents on the Mental Health of Patients with Chronic Hepatitis C: A Prospective Observational Study. Brain Sci 2020; 10:E483. [PMID: 32726940 PMCID: PMC7463817 DOI: 10.3390/brainsci10080483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
Abstract
In chronic hepatitis C (CHC) patients, interferon-based treatments showed toxicity, limited efficacy, and psychiatric manifestations. Direct-acting antiviral (DAA) agents appeared safer, though it remains unclear if they may exacerbate or foster mood symptoms in drug-naïve CHC patients. We evaluated 62 CHC patients' mental status, before and 12 weeks after DAA therapy, by assessment scales and psychometric instruments. We subdivided patients into two groups, CHC patients with (Group A) or without (Group B) a current and/or past psychiatric history. After DAA treatment, Group A patients showed low anxiety and improved depression, no variation in self-report distress, but worse general health perceptions. No significant difference emerged from coping strategies. Depression and anxiety improved in Group B, and no change emerged from total self-reported distress, except for somatization. Moreover, Group B increased problem-focused strategies for suppression of competing activities, and decreased strategies of instrumental social support. Contrarily, Group B reduced significantly emotion-focused strategies, such as acceptance and mental disengagement, and improved vitality, physical and social role functioning. DAA therapy is safe and free of hepatological and psychiatric side effects in CHC patients, regardless of current and/or past psychiatric history. In particular, patients without a psychiatric history also remarkably improved their quality of life.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Rosa Zampino
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
- Internal Medicine, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 1, 80138 Naples, Italy
| | - Martina Vitrone
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Lucia Del Gaudio
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Daniela Nunziata
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Salvatore Agnese
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Anna Santagata
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Emanuele Durante-Mangoni
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
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Mallolas J, Ahumada A, Ampuero J, Blanco JR, Hidalgo Á, Londoño MC, Molina E, Ruiz S. Quality of life in patients with hepatitis C. Importance of treatment. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 42 Suppl 1:20-25. [PMID: 32560769 DOI: 10.1016/s0210-5705(20)30184-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic hepatitis C virus infection is a systemic disease that impairs the quality of life of affected individuals. The impairment is not only due to physiological factors, such as the non-hepatic manifestations of the disease or certain symptoms such as fatigue, weakness and nausea, but is also due to the substantial psychological impact of the infection. Treatment with direct-acting antivirals (DAA) has been demonstrated to substantially improve patient's quality of life, starting in the initial phases. Supplement information: This article is part of a supplement entitled "The value of simplicity in hepatitis C treatment", which is sponsored by Gilead. © 2019 Elsevier España, S.L.U. All rights reserved.
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Affiliation(s)
- Josep Mallolas
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Barcelona, España.
| | - Adriana Ahumada
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Javier Ampuero
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas; Instituto de Biomedicina de Sevilla, Sevilla, España; Universidad de Sevilla, Sevilla, España
| | - José Ramón Blanco
- Servicio de Enfermedades Infecciosas, Hospital San Pedro, Logroño, España
| | - Álvaro Hidalgo
- Economista de Salud, Universidad de Castilla-La Mancha, Ciudad Real, España
| | | | - Esther Molina
- Servicio de Aparato Digestivo, Hospital Clínico Universitario de Santiago, A Coruña, España
| | - Salvador Ruiz
- Psiquiatría de Urgencias, Hospital Universitario Príncipe de Asturias, Madrid, España
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Rolland B, Bailly F, Cutarella C, Drevon O, Carrieri P, Darque A, Hallouche N, Maptue N, Pol S, Llorca PM, Lang JP. [Hepatitis C in a psychiatric setting: A forgotten reservoir?]. Encephale 2020; 47:181-184. [PMID: 32473777 DOI: 10.1016/j.encep.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
Hepatitis C is a transmissible hepatic and extra-hepatic disease caused by the hepatitis C virus (HCV). HCV develops into a chronic infection among approximately 70% of the contaminated subjects. Chronic HCV infection is estimated to affect between 0.5% and 1 % of the general population in France, which causes an important burden of disease, in particular due to the occurrence of cirrhosis and liver cancer. New antiviral drugs now allow to cure more than 95% of patients in just a few weeks of treatment with very limited safety issues. This therapeutic revolution has led the World Health Organization and many national governments to aim for an elimination of HCV, which has been defined as a 90%-reduction of the incidence rate, and a 65%-reduction in the number of HCV-related deaths on the basis of the 2015 figures. In this respect, the French Ministry of Health has recently decided to extend the ability to prescribe the new antiviral drugs to any physician. However, the elimination campaign of HCV will also need to correctly identify, screen, and treat the main target populations. If people who inject drugs (PWIDs) certainly constitute the most important population concerned by the challenge of HCV elimination, more hidden reservoirs in which HCV transmission can insidiously evolve should be identified and specifically targeted as well. Inpatient psychiatric populations might constitute one of these hidden reservoirs. International data suggest that chronic HCV infection affects approximately 5% of psychiatric inpatients in Europe. This very high prevalence estimate can in part be due to the very frequent psychiatric disorders found among the current or former PWIDs. However, a part of the seropositive patients does not report a history of drug use, and other factors could contribute to the increased risk of contamination in this population including atypical routes of transmission related to institutional promiscuity. Exploring the general profile and risk-behaviors of the psychiatric inpatients found infected by the HCV is thus warranted for future studies. Screening and treating HCV in the specific population of psychiatric patients is part of the general public health objective of eliminating HCV at a national level. Moreover, it also directly fits into the individualized psychiatric care. Many recent data suggest that HCV also has a neural tropism, in particular within glial cells, such as astrocytes or oligodendrocytes. As such, HCV foments inflammatory processes in the brain and contributes to cognitive impairments and psychiatric symptoms such as anxiety or depression. At the individual level, treating HCV infection can improve the psychiatric state and increase patients' outcomes in terms of well-being and quality of life. For all these reasons, the field of psychiatry needs local and national actions for informing and training professionals about HCV screening and treating modalities. Patient and family associations also need to be involved in this general effort of micro-elimination. A key role should be assigned to the general practitioners embedded within inpatient psychiatric units. They are the best fitted professionals to screen, treat, and empower patients, to inform and train other caregivers of the psychiatric field, and to act as a relay with hepatology teams if required. Hospital pharmacists are other important stakeholders. In a national context in which the funding of psychiatric care, including medications, is based on predefined funding envelops, innovative initiatives will have to be set up by local or national health authorities, in partnership with pharmacists, to allow for the treatment of psychiatric inpatients. In conclusion, the world of psychiatry is a possible hidden reservoir of HCV and, as such, a part of the challenge for eliminating the virus. Patients, families, and caregivers will have to be correctly sensitized and trained to play their role in the process. Specific investigations will be required to better understand why such an increased prevalence of HCV is observed in this population. Specific adaptations of the cascade of care within psychiatric settings, including access to treatment, will need to be designed, implemented, and evaluated for reaching micro-elimination of HCV in psychiatry.
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Affiliation(s)
- B Rolland
- Service universitaire d'addictologie de Lyon (SUAL), CH Le Vinatier, hospices civils de lyon, université de Lyon, UCBL, Lyon, France.
| | - F Bailly
- Service d'hépatologie et d'addictologie, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - C Cutarella
- Clinique Saint-Barnabé, Ramsay-Générale de Santé, Marseille, France
| | - O Drevon
- Santé basque développement, Bayonne, France
| | - P Carrieri
- SESSTIM, Sciences économiques & sociales de la santé & traitement de l'information médicale, Aix Marseille Univ, Inserm, IRD, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - A Darque
- Pharmacie centrale, hôpital de la Conception, APHM, Marseille, France
| | - N Hallouche
- GHU Paris Psychiatrie et Neurosciences, Paris, France; Association nationale pour la promotion des soins somatiques en santé mentale (ANP3SM), Paris, France
| | - N Maptue
- Centre mutualiste d'addictologie de Saint-Galmier, Mutualité française Loire - Haute Loire SSAM - Eovi Mcd santé et services, Saint-Etienne, France
| | - S Pol
- Unité d'hépatologie, Assistance publique-Hôpitaux de Paris, hôpital Cochin, Paris, France; Université de Paris, Inserm U-1223, Institut Pasteur, Paris, France
| | - P-M Llorca
- CMP B, CHU, EA 7280, Université Clermont Auvergne, Clermont-Ferrand, France
| | - J-P Lang
- Les Toises Centre de Psychiatrie et Psychothérapie, Lausanne, Suisse; Centre d'information régional sur les drogues et dépendances Alsace, Strasbourg, France
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36
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Abstract
Hepatits C virus (HCV) infection has been largely associated with extrahepatic comorbidities such as diseases related to dysregulation of the immune system, neuropsychiatric disorders, and cardiometabolic alterations. These clinical consequences, together with experimental evidence, suggest a potential (in)direct effect of HCV, contributing to the pathogenesis of these diseases. Various studies have reported a positive effect of viral eradication on occurrence and outcomes of extrahepatic diseases. These observations and the availability of safe and effective direct antiviral agents further underline the need to search for virological eradication in all infected individuals independent of the severity of the liver disease.
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Affiliation(s)
- Salvatore Petta
- Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Italia.
| | - Antonio Craxì
- Sezione di Gastroenterologia e Epatologia, PROMISE, Università di Palermo, Italia
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37
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Abou-Hashem RM, Shaat MM, Hamza SA, Mahmoud NH, Ali SM. The Relationship between Trace Elements and Depression among Older Patients with Chronic Liver Disease. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/7887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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38
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de Gennaro N, Diella L, Monno L, Angarano G, Milella M, Saracino A. Efficacy and tolerability of DAAs in HCV-monoinfected and HCV/HIV-coinfected patients with psychiatric disorders. BMC Infect Dis 2020; 20:196. [PMID: 32138757 PMCID: PMC7059311 DOI: 10.1186/s12879-020-4922-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/26/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Few data are available regarding the use of direct antiviral agents (DAAs) for chronic hepatitis C in psychiatric patients. The aim of the study is to assess safety and outcome of DAAs in patients with psychiatric comorbidities. METHODS This retrospective, observational, single-centre study enrolled patients treated with psychiatric drugs who initiated DAAs between 2015 and 2018. Patients were classified into two groups: A (on anxiolitycs/antidepressant) and B (on antipsychotics). Week-12 sustained virological response (SVR-12) and adverse events (AEs) were evaluated. RESULTS One hundred forty-four patients were included (A:101; B:43). Patients were 49.3% males, mean age 60 years (SD ± 13.5); 31.9% cirrhotic; 125 (86.8%) HCV-monoinfected and 19 (13.2%) HCV /HIV-coinfected. Twenty patients (13.8%) required a change of psychiatric therapy before initiation of DAA. Overall, SVR-12 was achieved in 88.2% of subjects in intention-to-treat(ITT)-analysis. Lower SVR rates were observed in group B vs A (79% vs 92%, p = 0.045) and in those changing psychiatric drugs vs others (8% vs 30%, p = 0.015). According to per-protocol (PP)-analysis, SVR-12 was achieved in 93/95 (97.9%) in group A versus 34/36 (94.4%) in group B (p = 0.30). At least one AE occurred in 60 patients (41.6%), including 10 severe AEs, leading to 3 discontinuations. AEs were more frequently reported in group A (p = 0.015). CONCLUSIONS The study confirms effectiveness and safety of DAA-based treatment also in this special population, even if a careful evaluation of history and drug-drug interactions is warranted.
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Affiliation(s)
- Nicolò de Gennaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy.
| | - Lucia Diella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Gioacchino Angarano
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Piazza Giulio Cesare n. 11, 70124, Bari, Italy
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39
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Chiu WC, Lu ML, Chang CC. Mental Disorders and Interferon Nontreatment in Hepatitis C Virus Infection-a Population Based Cohort Study. Psychiatry Investig 2020; 17:268-274. [PMID: 32151125 PMCID: PMC7113179 DOI: 10.30773/pi.2019.0254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/08/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study investigates the association between mental disorders and interferon nontreatment in patients with chronic hepatitis C virus (HCV) infection in a large national sample. METHODS Using the National Health Insurance Research Database of Taiwan, we conducted a nationwide population-based study. Each case was matched to five controls by age, sex, urbanization, and income. Conditional logistic regression was used to assess odds of HCV nontreatment in different mental disorders. RESULTS From 1999 to 2013, we identified 92,970 subjects with HCV infection and 15,495 HCV cases (16.7%) had received IFN therapy. Other than chronic obstructive pulmonary disease, the medical diseases and mental disorders were significantly different between IFN and non-IFN treated HCV patients. After adjusting for medical diseases, depressive disorder and anxiety disorder was positively associated with receiving IFN therapy. Patients with schizophrenia, bipolar disorders and alcohol use disorders were significantly less likely to receive interferon. Antidepressant exposure (cumulative daily exposure or cumulative daily dose) was associated with lower odds of IFN treatment. CONCLUSION Our nationwide cohort study demonstrated that INF nontreatment rate was lower in certain mental disorders. Antidepressant exposure might lower the chance of receiving IFN treatment. Our results may help to identify and to overcome the obstacles for HCV treatment and further apply to DAAs regimen.
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Affiliation(s)
- Wei-Che Chiu
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Center of General Education, Tunghai University, Taichung, Taiwan
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40
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Lin CY, Guu TW, Lai HC, Peng CY, Chiang JYJ, Chen HT, Li TC, Yang SY, Su KP, Chang JPC. Somatic pain associated with initiation of interferon-alpha (IFN-α) plus ribavirin (RBV) therapy in chronic HCV patients: A prospective study. Brain Behav Immun Health 2020; 2:100035. [PMID: 34589826 PMCID: PMC8474510 DOI: 10.1016/j.bbih.2019.100035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/21/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022] Open
Abstract
Objective This study is aimed to investigate the association between interferon-alpha (IFN-α) plus ribavirin (RBV) treatment and emergence of somatic pain symptoms in patients with hepatitis C virus (HCV) over a 24-week treatment. Method In this prospective cohort study, 297 patients with HCV were evaluated at baseline and 2nd, 4th, 8th, 12th, 16th, 20th, and 24th week with structured Mini-International Neuropsychiatric Interview for Major Depressive Disorder (MDD) diagnosis and the Neurotoxicity Rating Scale (NRS) for somatic symptoms. Results Eighty-seven out of the 297 patients (29%) developed IFN-α induced depression and had significantly higher somatic pain symptoms as early as the 2nd week and at all the assessment time points (p < .001). Most depressed patients perceived greatest somatic pain at the 8th week of treatment. Moreover, NRS somatic pain scores after initial therapy strongly correlated with NRS somatic pain scores at all other assessment time points (p < .001). Conclusion IFN-α therapy induce significant somatic pain as early as the 2nd week of treatment in HCV patients who later developed MDD. Thus, initial NRS somatic pain score after initiation of IFN-α treatment may serve as a reference for the susceptibility of the individual to IFN-α induced depression.
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Affiliation(s)
- Chih Ying Lin
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Ta-Wei Guu
- Department Psychiatry, CMU Beigang Hospital, Yunlin, Taiwan
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Hsueh-Chou Lai
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Departement of Hepatogastroenterology, China Medial University Hospital, Taichung, Taiwan
| | - Cheng-Yuan Peng
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Departement of Hepatogastroenterology, China Medial University Hospital, Taichung, Taiwan
| | - Jill Yi-Ju Chiang
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Hui-Ting Chen
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Tsai-Chung Li
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- China Medical University Graduate Institute of Biostatistics, Taiwan
| | - Shing-Yu Yang
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- China Medical University Graduate Institute of Biostatistics, Taiwan
| | - Kuan-Pin Su
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
| | - Jane Pei-Chen Chang
- School of Medicine, China Medical University (CMU), Taichung, Taiwan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Mind-Body Interface Lab (MBI-Lab) and Department of Psychiatry, CMUH, Taichung, Taiwan
- Corresponding author. Department of Psychiatry, China Medical University Hospital, No. 2 Yu-Der Road, Taichung, 404, Taiwan.
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41
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Barreira DP, Marinho RT, Bicho M, Flores I, Fialho R, Ouakinin S. Hepatitis C Pretreatment Profile and Gender Differences: Cognition and Disease Severity Effects. Front Psychol 2019; 10:2317. [PMID: 31681109 PMCID: PMC6804525 DOI: 10.3389/fpsyg.2019.02317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background The hepatitis C virus (HCV) is known to infect the brain, however, the findings based on associated neuropsychiatric syndrome are controversial and the association itself remains unclear. Gender research in HCV infection is limited, failing to integrate the role of gender differences in neurocognitive syndrome. The aim of this study was to characterize psychological and neurocognitive profiles in HCV-infected patients before treatment and to explore gender differences in those profiles, as well as the impact of disease severity. Methods A total of 86 patients diagnosed with chronic hepatitis C were included. Depression and anxiety were assessed using Hamilton anxiety scale (HAM-A), Hamilton depression scale (HAM-D), Beck Depression Inventory (BDI). For cognition, a neuropsychological battery to measure attention, concentration and memory was used, and executive function components validated for the Portuguese population was also used before starting treatment. To identify the disease severity, platelet ratio index, and FibroScan® were used. Results A statistically significant gender effect was found on HAM-A (B = 0.64, CI: 0.17–1.11) and HAM-D (B = 0.62, CI: 0.14–1.09), with women scoring higher compared to men. Regarding neuropsychological scores, significant differences between gender were identified in executive functions measured by Trail Making Test (TMT B) (B = 0.48, CI: 0.02–0.97), TMT B-A (B = 0.26, CI: −39.2 to −3.7) and in digit span total (B = −0.52, CI: −1.0 to −0.04), with women performing worse than men. Controlling for years of substance dependence, TMT-B and TMT B-A showed significant gender differences. Regarding the presence or absence of substance dependence, only HAM-A and HAM-D remained significant. For categorical variables, Digit Span Total was also influenced by gender, with women being more likely to be impaired: odds ratio (OR) = 7.07, CI: 2.04–24.45), and a trend was observed for Digit Span Backward (OR = 3.57, CI: 1.31–9.75). No significant differences were found between disease severity and neurocognitive performance. Conclusion Data suggest that gender has an influence on depression, anxiety and cognitive functions with women showing greater impairment compared with men. This effect seems to be influenced by substance dependence.
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Affiliation(s)
- David Pires Barreira
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
| | - Rui Tato Marinho
- Faculdade de Medicina, Universidade de Lisboa, Serviço de Gastrenterologia e Hepatologia, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
| | - Manuel Bicho
- Laboratório de Genética, Faculdade de Medicina, Instituto de Saúde Ambiental, Universidade de Lisboa, Lisbon, Portugal
| | - Isabel Flores
- ISCTE, IUL, Centro de Investigação em Estudos Sociais, Lisbon, Portugal
| | - Renata Fialho
- Immunopsychiatric Clinic, Research and Development, Sussex Partnership NHS Foundation Trust, Brighton and Hove, United Kingdom
| | - Sílvia Ouakinin
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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42
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Sforzini L, Nettis MA, Mondelli V, Pariante CM. Inflammation in cancer and depression: a starring role for the kynurenine pathway. Psychopharmacology (Berl) 2019; 236:2997-3011. [PMID: 30806743 PMCID: PMC6820591 DOI: 10.1007/s00213-019-05200-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/13/2019] [Indexed: 12/13/2022]
Abstract
Depression is a common comorbidity in cancer cases, but this is not only due to the emotional distress of having a life-threatening disease. A common biological mechanism, involving a dysregulated immune system, seems to underpin this comorbidity. In particular, the activation of the kynurenine pathway of tryptophan degradation due to inflammation may play a key role in the development and persistence of both diseases. As a consequence, targeting enzymes involved in this pathway offers a unique opportunity to develop new strategies to treat cancer and depression at once. In this work, we provide a systematic review of the evidence up to date on the kynurenine pathway role in linking depression and cancer and on clinical implications of this evidence. In particular, complications due to chemotherapy are discussed, as well as the potential antidepressant efficacy of novel immunotherapies for cancer.
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Affiliation(s)
- Luca Sforzini
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Maria Antonietta Nettis
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.
- National Institute for Health and Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
| | - Valeria Mondelli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
- National Institute for Health and Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Carmine Maria Pariante
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
- National Institute for Health and Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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43
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Lin MS, Chung CM, Lin WY, Wei KL, Wang J, Lee YY, Hu JH, Tung TH, Lin YS. Antiviral therapy reduces risk of haemorrhagic stroke in patients with HCV infection: a nationwide cohort study. Antivir Ther 2019; 23:43-52. [PMID: 28471350 DOI: 10.3851/imp3172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The tendency for haemorrhagic stroke in patients with chronic HCV infection has emerged recently but the finding may be confounded by comorbidities. Proving the causality between HCV infection and haemorrhagic stroke is mandatory. Our study was designed to investigate the incidence of intracranial haemorrhage in HCV-infected patients with and without treatment. METHODS In the 11-year and population-based retrospective study, we acquired data from the Taiwan National Health Insurance Research Database. The patients with major comorbidities were excluded and 97,198 HCV-infected patients were included for analysis. Treated and untreated cohorts were matched with propensity score to make the confounding factors in two groups comparable. Cox proportional hazard regression analysis was performed to evaluate the hazard ratio of haemorrhagic stroke in the cohorts. We applied survival analysis to compare the cumulative incidence of outcome events between the two cohorts. RESULTS After matching, the incidence density (ID) of haemorrhagic stroke in the untreated cohort is significantly higher than in the treated cohort (ID: 1.0 versus 0.6 events per 1,000 person-years; P=0.0014). The adjusted hazard ratio (aHR) of haemorrhagic stroke is significantly reduced in the treated group (P<0.05). Cumulative incidence of haemorrhagic stroke is significantly lower in the treated group than in the untreated group (P=0.013). CONCLUSIONS The study demonstrates that antiviral therapy significantly reduces the events of intracranial haemorrhage in HCV-infected patients and consolidates the novel concept that chronic HCV infection is a risk factor for haemorrhagic stroke.
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Affiliation(s)
- Ming-Shyan Lin
- Department of Cardiology, Department of Internal Medicine, Liver Research Center, Chang-Gung Memorial Hospital, Yunlin, Taiwan
| | - Chang-Min Chung
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wey-Yil Lin
- Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital, and Chang Gung University, Linkou, Taiwan
| | - Kuo-Liang Wei
- Department of Hepato-Gastroenterology and Liver Research Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ying-Ying Lee
- Department of Neurology, Landseed Hospital, Taoyuan, Taiwan
| | - Jing-Hong Hu
- Department of Hepato-Gastroenterology and Liver Research Center, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan.,Department of Public Health, School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Yu-Sheng Lin
- Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital, and Chang Gung University, Linkou, Taiwan
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44
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Forton D, Weissenborn K, Bondin M, Cacoub P. Expert opinion on managing chronic HCV in patients with neuropsychiatric manifestations. Antivir Ther 2019; 23:47-55. [PMID: 30451150 DOI: 10.3851/imp3245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 10/27/2022]
Abstract
Neurological manifestations of HCV infection appear to be under-recognized in clinical practice despite the majority of HCV-infected patients experiencing symptoms such as fatigue, depression and cognitive dysfunction. There is also growing evidence for a link between HCV infection and an increased risk of Parkinson's disease. The mechanism underpinning the association between HCV and these neuropsychiatric syndromes still requires further investigation. Here we review the pre-clinical and clinical evidence for a link between HCV and effects on the central nervous system leading to neuropsychiatric syndromes. Lastly, we describe how improvements in neuropsychiatric manifestations of HCV following treatment have been observed, which is subsequently reflected in an overall improvement in health-related quality of life.
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Affiliation(s)
- Daniel Forton
- Department of Gastroenterology and Hepatology, St George's Hospital London, London, UK.,St George's University of London, London, UK
| | | | | | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France.,INSERM, UMR_S 959, Paris, France.,CNRS, FRE3632, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
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45
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Whale R, Fialho R, Field AP, Campbell G, Tibble J, Harrison NA, Rolt M. Factor analyses differentiate clinical phenotypes of idiopathic and interferon-alpha-induced depression. Brain Behav Immun 2019; 80:519-524. [PMID: 31029797 DOI: 10.1016/j.bbi.2019.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/05/2019] [Accepted: 04/24/2019] [Indexed: 12/19/2022] Open
Abstract
The discovery that prolonged administration of interferon-alpha (a pro-inflammatory cytokine) readily precipitates depressive symptoms has played a key role in development of the inflammation theory of major depressive disorder (MDD). However, it remains unclear whether the clinical phenotype of patients with inflammation-associated depression significantly overlaps with, or can be distinguished from that of patients with 'idiopathic' depression. Here we explored the Hamilton depression scale factor structure of 172 patients undergoing interferon-alpha treatment for hepatitis-C at the point of transition to a depressive episode of DSM IV defined major depression severity. The resulting factor structure was first compared with a model derived from 6 previous studies of 'idiopathic' MDD (Cole et al., 2004). This confirmatory factor analysis revealed that the factor structure of HAMD scores in our interferon-alpha treated cohort did not plausibly fit that previously described for 'idiopathic' MDD. Instead, subsequent exploratory factor analysis revealed a distinct four factor model with a novel primary factor grouping cognitive symptoms of depression and anxiety (HAMD items 1, 2, 9, 10, 11, 15). The second sleep disorder factor (items 4, 5, 6) replicated previous findings in 'idiopathic' depression. A third and unique factor grouped somatic symptoms and function (items 7, 12, 13, 14 and item 1). The final factor (also common in idiopathic depression studies), grouped gastrointestinal symptoms and weight loss (items 12 and 16). Severe depression items (3, 8, and 17) were excluded from analysis due to very low variance. At transition, interferon-alpha induced major depressive episodes therefore appears to have more associated anxiety features that covary with depressed mood than classical or 'idiopathic' MDD and a low likelihood of severe features such as suicidal ideation. Identification of this clinical phenotype may help identify patients with an inflammatory depression etiology and support the development of more effective and personalized therapies.
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Affiliation(s)
- Richard Whale
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; Department of Neuroscience, Brighton and Sussex Medical School, Brighton BN1 9RR, United Kingdom.
| | - Renata Fialho
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom
| | - Andy P Field
- School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom
| | - Graham Campbell
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom
| | - Jeremy Tibble
- Digestive Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE, United Kingdom
| | - Neil A Harrison
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; Department of Neuroscience, Brighton and Sussex Medical School, Brighton BN1 9RR, United Kingdom
| | - Michael Rolt
- Immunopsychiatry Research Clinic, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton BN3 7HZ, United Kingdom; School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom
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46
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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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47
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Inflammation, Monoclonal Antibodies and Depression: Joining the Dots. Drug Saf 2019; 42:811-812. [DOI: 10.1007/s40264-019-00819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Chen VCH, Lu ML, Yang YH, Weng JC, Chang CC. Antidepressant use and hepatocellular carcinoma in patients with hepatitis C who had received interferon therapy: A population-based cohort study. J Affect Disord 2019; 253:147-153. [PMID: 31035215 DOI: 10.1016/j.jad.2019.04.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/24/2019] [Accepted: 04/21/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Using data from the National Health Insurance (NHI) of Taiwan, we conducted a nationwide population-based cohort study to investigate the association between antidepressant (ATD) use and the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who had received interferon (IFN) therapy. METHODS This study included a total of 274,952 HCV-infected patients without hepatitis B virus infection who were enrolled in the NHI program between January 1, 1997 and December 31, 2013. Among these patients, only 10,713 (age ≥18 years) had received IFN therapy between 2004 and 2008. Among the patients who had received IFN therapy, 2014 had received ATDs, and 8684 had not. A Cox proportional hazards regression model was applied after adjusting for age, sex, income, urbanization, medical comorbidity, and medication use. RESULTS Compared with non-ATD-treated patients, ATD-treated patients were more likely to receive a diagnosis of alcohol-related disease, diabetes mellitus (DM), hypertension, and hyperlipidemia. ATD-treated patients had a significantly lower incidence of HCC than non-ATD-treated patients (P = 0.0019). Female, older (age ≥50 years), and non-DM patients who had received cumulative high doses of ATDs had a significantly lower risk of HCC than non-ATD-treated patients. After adjustment, only high-dose selective serotonin reuptake inhibitor (SSRI) use was inversely associated with HCC risk (adjusted hazard ratio 0.37, 95% confidence interval 0.19-0.71, P = 0.0027). CONCLUSIONS Our study showed that ATD use, especially a relatively high cumulative dose of SSRIs, in HCV-infected patients who had received IFN was associated with reduced HCC risk. Future clinical studies are warranted to explore the underlying mechanisms and to apply them to newer direct-acting antiviral agent treatments.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital & School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yao-Hsu Yang
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, No.135, Nanxiao Street, Changhua 50006, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Center of General Education, Tunghai University, Taichung, Taiwan.
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Sakamaki A, Kamimura K, Fukui N, Watanabe H, Sakai N, Tominaga K, Mizuno K, Takamura M, Kawai H, Sugai T, Yamagiwa S, Someya T, Terai S. A case report of psychiatric symptoms following direct-acting antiviral and ribavirin combination therapy for chronic hepatitis C in a patient with innate anxiety. BMC Gastroenterol 2019; 19:85. [PMID: 31195993 PMCID: PMC6567614 DOI: 10.1186/s12876-019-1013-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/06/2019] [Indexed: 12/27/2022] Open
Abstract
Background Direct-acting antivirals (DAAs) result in a highly sustained virological response rate and better patient tolerance. However, this therapeutic approach may, on rare occasions, give rise to psychiatric symptoms. We describe a case requiring discontinuation of DAA and ribavirin combination therapy due to psychiatric symptoms in a patient with congenital anxious personality traits. The information summarized here will be helpful to physicians treating chronic hepatitis C virus (HCV) infection in patients with underlying psychiatric problems. Case presentation A 57-year-old Japanese woman diagnosed with chronic HCV infection was prescribed DAA and ribavirin combination therapy. She had a history of mild innate anxiety and development of psychiatric symptoms due to interferon (IFN) therapy 8 years prior, which subsided with discontinuation of the therapy. Similar psychiatric symptoms such as enervation, palpitations, an episode of hyperventilation, and consciousness disturbances with myotonia were observed after the administration of the antiviral agents. No abnormal findings related to her symptoms were observed on laboratory or imaging results. Psychiatrists diagnosed the patient as having a somatization disorder induced by the antiviral agents on the basis of innate anxiety. After the discontinuation of therapy, her symptoms gradually improved. Conclusions Although DAAs were not causative factors for psychiatric symptoms in phase 3 studies, a post-marketing study reported psychiatric symptoms such as depression in patients with underlying psychiatric problems. Our case suggests psychiatric symptoms might worsen after DAA and ribavirin administration in patients with underlying psychiatric disorders, and therefore, close monitoring is necessary for these patients, especially if they have a history of psychiatric symptoms after IFN.
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Affiliation(s)
- Akira Sakamaki
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Naoki Fukui
- Division of Psychiatry, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Haruka Watanabe
- Division of Psychiatry, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Norihiro Sakai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Kenichi Mizuno
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Masaaki Takamura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takuro Sugai
- Division of Psychiatry, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Satoshi Yamagiwa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Toshiyuki Someya
- Division of Psychiatry, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
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Zhou E, Qiao Z, Cheng Y, Zhou J, Wang W, Zhao M, Qiu X, Wang L, Song X, Zhao E, Wang R, Zhao X, Yang Y, Yang X. Factors associated with depression among HIV/AIDS children in China. Int J Ment Health Syst 2019; 13:10. [PMID: 30828360 PMCID: PMC6381654 DOI: 10.1186/s13033-019-0263-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/22/2019] [Indexed: 02/05/2023] Open
Abstract
Background Depression in HIV/AIDS children not only worsens the progression and outcome of illness, but also impacts their quality of life, having a negative influence on society. The present study was conducted from a psychosocial perspective, considering children’s social desirability, cognitive emotion regulation, and perceived social support to identify the factors influencing depression in HIV-infected children in China. Methods Participants were 155 children aged 8–18 years who were eligible to participate in this study assessing depression and associated risk factors using the Children’s Depression Inventory, Cognitive Emotion Regulation Questionnaire, Multidimensional Scale of Perceived Social Support, and Children’s Social Desirability scale. Hierarchical linear regression analysis was conducted to model the effects of social desirability, perceived social support, and cognitive emotion regulation on depression in HIV/AIDS children. Results Statistically significant linear relationships were found among social desirability, perceived social support, partial dimensions of cognitive emotion regulation, and children’s depression scores. Perceived social support, planning and positive reappraisal were negatively related to the depression. Conversely, social desirability, catastrophizing and other-blame were positively associated with the depression. Linear regression analysis indicated that children’s social desirability, perceived social support, and one dimension of cognitive emotion regulation (catastrophizing) were found to significantly predict depression. Conclusions Psychosocial factors have an important influence on the depression experienced by HIV-infected children. Interventions from personal subjective psychosocial to reduce depression in HIV-infected children in China are warranted.
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Affiliation(s)
- Enpeng Zhou
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Zhengxue Qiao
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Yuewu Cheng
- Shangcai Center for Disease Control and Prevention, Zhumadian, Henan China
| | - Jiawei Zhou
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Wenbo Wang
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Mingzhe Zhao
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Xiaohui Qiu
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Lin Wang
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Xuejia Song
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Erying Zhao
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Ruopeng Wang
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Xueyan Zhao
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Yanjie Yang
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
| | - Xiuxian Yang
- 1Psychology Department of the Public Health Institute of Harbin Medical University, No. 157, Baojian Road, Nangang District, Harbin, 150081 Heilongjiang Province China
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