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Mao B, Liu S, Zhu S, Wu F, Yuan W, Yan Y, Wang B. The janus face of serotonin: Regenerative promoter and chronic liver disease aggravator. Heliyon 2024; 10:e30703. [PMID: 38756588 PMCID: PMC11096747 DOI: 10.1016/j.heliyon.2024.e30703] [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: 12/19/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
The progression of liver diseases, from viral hepatitis and fatty liver disease to cirrhosis and hepatocellular carcinoma (HCC), is the most representative series of pathological events in liver diseases. While serotonin (5-HT) primarily regulates brain functions such as psychology, mood, and appetite in the central nervous system (CNS), peripheral 5-HT plays a crucial role in regulating tumor development, glucose and lipid metabolism, immune function and inflammatory response related to liver diseases. These peripheral physiological processes involving 5-HT are the key mechanisms driving the development of these liver diseases. This study presents an overview of the existing literature, focusing on the role of 5-HT in HCC, cirrhosis, fatty liver disease, viral hepatitis, and liver injury. In summary, while 5-HT promotes liver regeneration, it can also contribute to the progression of chronic liver disease. These findings indicate the potential for the development and use of 5-HT-related drugs for the treatment of liver diseases, including HCC and cirrhosis.
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Affiliation(s)
- Benliang Mao
- Department of General Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
- College of Clinical Medicine, Guizhou Medical University, Guiyang, China
| | - Shoupei Liu
- Laboratory of Stem Cells and Translational Medicine, Institutes for Life Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Shanfei Zhu
- Department of General Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Fan Wu
- Department of General Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Wei Yuan
- Department of General Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yong Yan
- Department of General Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Bailin Wang
- Department of General Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
- College of Clinical Medicine, Guizhou Medical University, Guiyang, China
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2
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Akhter Z, Todowede O, Brown JVE, Jarde A, Mazhar L, narasimha VL, Muhammad S, Fazid S, Rehman K, Deshmukh C, Ayinla A, Wuraola F, Ashraf MN, Siddiqi N. Pharmacological interventions for depression in adults with chronic hepatitis B or C. Hippokratia 2022. [DOI: 10.1002/14651858.cd015037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Zohaib Akhter
- York Trials Unit, Department of Health Sciences; University of York; York UK
| | - Olamide Todowede
- Faculty of Medicine & Health Sciences; University of Nottingham; Nottingham UK
| | | | - Alexander Jarde
- INSERM, INRAE, CNAM, Centre of Research in Epidemiology and Statistics (CRESS); Cochrane; Paris France
- Centre d'Épidémiologie Clinique; AP-HP, Hôpital Hôtel-Dieu; Paris France
- Cochrane France; Paris France
| | - Laraib Mazhar
- Department of Medicine , The Aga Khan University; Karachi Pakistan
| | | | - Sagir Muhammad
- Obstetrics and Gynaecology; Specialist Hospital; Gombe Nigeria
- Obstetrics and Gynaecology; Gombe State University; Gombe Nigeria
| | - Sheraz Fazid
- Institute of Public Health & Social Sciences, Khyber Medical University; Peshawar Pakistan
| | - Khalid Rehman
- Institute of Public Health & Social Sciences, Khyber Medical University; Peshawar Pakistan
| | | | - Akeemat Ayinla
- African Center of Excellence for Genomics of Infectious Diseases; Ede Nigeria
| | | | - Mir Nabila Ashraf
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division; International Centre for Diarrhoeal Disease Research Bangladesh; Dhaka Bangladesh
| | - Najma Siddiqi
- Department of Health Sciences; University of York, Hull York Medical School; York UK
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3
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Borsini A, Pariante CM, Zunszain PA, Hepgul N, Russell A, Zajkowska Z, Mondelli V, Thuret S. The role of circulatory systemic environment in predicting interferon-alpha-induced depression: The neurogenic process as a potential mechanism. Brain Behav Immun 2019; 81:220-227. [PMID: 31207337 PMCID: PMC6934231 DOI: 10.1016/j.bbi.2019.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/15/2019] [Accepted: 06/13/2019] [Indexed: 12/20/2022] Open
Abstract
Interferon (IFN)-α treatment for hepatitis C virus (HCV) is a well-recognized clinical model for inflammation-induced depression, but the brain cellular mechanisms underlying these effects are still not clear. Previous data reported an alteration in peripheral levels of inflammatory and neuroplasticity markers in the blood of depressed versus non-depressed patients. We investigated the in vitro effect of serum from depressed and non-depressed HCV patients (at baseline, before IFN-α; and after four weeks of IFN-α), on the apoptotic and neurogenic processes in a human hippocampal progenitor cells model. Results show that higher apoptosis during proliferation observed upon treatment of cells with baseline serum, and lower neuronal differentiation observed upon treatment with serum after 4 weeks of IFN-α, were predictive of later development of IFN-α-induced depression (odds ratio = 1.26, p = 0.06, and = 0.80, p = 0.01, respectively). While serum after IFN-α increased neurogenesis compared with baseline serum, a lower increase in neurogenesis was also predictive of later development of depression (odds ratio = 0.86; p = 0.006). Our results provide evidence for the fundamental role of the systemic milieu (captured by serum samples) in the regulation of hippocampal neurogenesis by inflammation, a putative mechanism involved in the development of neuropsychiatric conditions.
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Affiliation(s)
- Alessandra Borsini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Patricia A Zunszain
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nilay Hepgul
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Alice Russell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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4
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Kumada H, Mochida S, Nakamuta M, Suzuki F, Yagi T, Takasaki R, Okai M, Kamiya N, Okada Y, Hirota S, Orihashi M, Ochi M, Chayama K. Efficacy and safety of telaprevir with natural human interferon-β and ribavirin in Japanese chronic hepatitis C patients with depression. Hepatol Res 2018; 48:184-192. [PMID: 28497489 DOI: 10.1111/hepr.12914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 03/16/2017] [Accepted: 05/09/2017] [Indexed: 12/16/2022]
Abstract
AIM To assess the efficacy and safety of telaprevir (TVR) when used in combination with natural human interferon-β (IFN-β) and ribavirin (RBV) for genotype 1 patients with depression compared to IFN-β/RBV therapy in Japan. We also examined the efficacy of the TVR/IFN-β/RBV therapy in treatment failure genotype 2 patients with depression. METHODS For the genotype 1 patients, 30 patients received TVR (750 mg every 8 h) for 12 weeks combined with IFN-β and RBV for 24 weeks (Group A), and 30 received IFN-β and RBV for 48 weeks (Group B). For the genotype 2 patients, 14 patients were dosed only with the TVR-based regimen. RESULTS The sustained virologic response (SVR) rates for Group A and Group B were 63.3% and 20.0%, respectively (P = 0.001, likelihood ratio test). The SVR rate for genotype 2 patients previously treated with pegylated IFN and/or RBV was 71.4%. No patient dropped out due to exacerbation of depression. The trend of platelet counts after the drugs were given was similar in the TVR/IFN-β/RBV therapy group and the IFN-β/RBV therapy group. Common resistance-associated variants of TVR were identified in 4 of the 13 patients who did not achieve SVR. CONCLUSION This study showed that an addition of TVR to IFN-β/RBV therapy raised SVR in previously treated and untreated genotype 1 patients and previously treated genotype 2 patients with chronic hepatitis C and depression.
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Affiliation(s)
| | - Satoshi Mochida
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Makoto Nakamuta
- Department of Gastroenterology, Kyushu Medical Center, Clinical Research Center, National Hospital Organization, Fukuoka, Japan
| | | | - Takashi Yagi
- Pharmaceutical Clinical Research Department, Toray Industries, Inc., Tokyo, Japan
| | - Ryuji Takasaki
- Pharmaceutical Clinical Research Department, Toray Industries, Inc., Tokyo, Japan
| | - Masao Okai
- Pharmaceutical Clinical Research Department, Toray Industries, Inc., Tokyo, Japan
| | - Naohiro Kamiya
- SOHYAKU. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Yasushi Okada
- IKUYAKU. Integrated Value Development Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Saya Hirota
- SOHYAKU. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Madori Orihashi
- SOHYAKU. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Miyoko Ochi
- SOHYAKU. Innovative Research Division, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
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5
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Michel L, Lions C, Winnock M, Lang JP, Loko MA, Rosenthal E, Marchou B, Valantin MA, Morlat P, Roux P, Sogni P, Spire B, Poizot-Martin I, Lacombe K, Lascoux-Combe C, Duvivier C, Neau D, Dabis F, Salmon-Ceron D, Carrieri MP. Psychiatric and substance use disorders in HIV/hepatitis C virus (HCV)-coinfected patients: does HCV clearance matter? [Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) HEPAVIH CO13 cohort]. HIV Med 2017; 17:758-765. [PMID: 27187027 DOI: 10.1111/hiv.12382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this nested study was to assess the prevalence of psychiatric disorders in a sample of HIV/hepatitis C virus (HCV)-coinfected patients according to their HCV status. METHODS The nested cross-sectional study, untitled HEPAVIH-Psy survey, was performed in a subset of HIV/HCV-coinfected patients enrolled in the French Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) CO13 HEPAVIH cohort. Psychiatric disorders were screened for using the Mini International Neuropsychiatric Interview (MINI 5.0.0). RESULTS Among the 286 patients enrolled in the study, 68 (24%) had never received HCV treatment, 87 (30%) were treatment nonresponders, 44 (15%) were currently being treated and 87 (30%) had a sustained virological response (SVR). Of the 286 patients enrolled, 121 patients (42%) screened positive for a psychiatric disorder other than suicidality and alcohol/drug abuse/dependence, 40 (14%) screened positive for alcohol abuse/dependence, 50 (18%) screened positive for drug abuse/dependence, 50 (17.5%) were receiving an antidepressant treatment and 69 (24%) were receiving an anxiolytic. Patients with an SVR did not significantly differ from the other groups in terms of psychiatric disorders. Patients receiving HCV treatment screened positive less often for an anxiety disorder. The highest rate of drug dependence/abuse was among HCV treatment-naïve patients. CONCLUSIONS Psychiatric disorders were frequent in HIV/HCV-coinfected patients and their rates were comparable between groups, even for patients achieving an SVR. Our results emphasize the need for continuous assessment and care of coinfected patients, even after HCV clearance. Drug addiction remains an obstacle to access to HCV treatment. Despite the recent advent and continued development of directly acting antiviral agents (DAAs), it is still crucial to offer screening and comprehensive care for psychiatric and addictive disorders.
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Affiliation(s)
- L Michel
- Inserm U1178, Paris, France. .,UMRS1178, Paris-Sud University and Paris Descartes University, Paris, France. .,Centre Pierre Nicole, French Red Cross, Paris, France.
| | - C Lions
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
| | | | - J-P Lang
- CHRU Strasbourg, Strasbourg, France
| | | | | | | | - M-A Valantin
- Groupe Hospitalier La Pitié Salpêtrière, Paris, France
| | - P Morlat
- Hôpital Saint-André, Bordeaux, France
| | - P Roux
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
| | - P Sogni
- Hôpital Cochin, Paris, France
| | - B Spire
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
| | | | - K Lacombe
- Hôpital Saint-Antoine, Paris, France
| | | | | | - D Neau
- Hôpital Pellegrin, Bordeaux, France
| | - F Dabis
- Inserm U897, Bordeaux, France
| | | | - M P Carrieri
- Inserm U912 (SESSTIM), Marseille, France.,IRD, UMR-S912, Aix Marseille University, Marseille, France.,Regional Center for Disease Control Provence Alpes Côte d'Azur, Marseille, France
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6
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Rado J. Neuropsychiatric Complications of Injection-Associated Diseases: HIV and Hepatitis C. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20161201-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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7
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Kasraian L, Negarestani N, Karimi MH, Dehbidi S. A Survey on the Prevalence of Depression in Blood Donors with Hepatitis C in Shiraz. HEPATITIS MONTHLY 2016; 16:e31080. [PMID: 28070197 PMCID: PMC5203680 DOI: 10.5812/hepatmon.31080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 07/27/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depression is the most common psychiatric disorder associated with hepatitis C. OBJECTIVES This study aimed to survey the prevalence rate of depression in patients with Hepatitis C Virus (HCV) before they were aware of their HCV test result. METHODS This cross-sectional study was conducted on all blood donors with confirmed positive HCV test results who donated blood between March 21, 2012 to March 21, 2013 at Fars blood transfusion center in Iran as case group and age- and sex-matched blood donors with negative screening test results as control group. A semi-structured interview based on DSM IV-TR depressive disorder criteria and Beck depression inventory (BDI) was conducted. BDI contained 21 items, each scored from 0 to 3 and total score of 0 to 63 for the whole scale computed by summing up all the items. A cut-off score of ≥ 19 indicated clinically significant depressive symptoms. The prevalence rate and risk factors of depression were determined. RESULTS The most frequent risk factors for HCV infection were intravenous drug abuse (59.3%), unsafe sexual contact (30.5%), and history of being imprisoned (25.4%). The prevalence rate of depression in the HCV group was 55.9 % (95% CI: 42.99% - 68.87%) that was significantly higher than the corresponding rate of the control group as 17.7 % ( 95% CI: 8.49% - 28.79%) (P < 0.001). The severity of depression was also more in the HCV group (P < 0.001). Besides, the prevalence rate of depression was higher among HCV patients with lower education level, previous history of drug abuse, unsafe sexual contact, and previous history of psychiatric diseases. The prevalence rate of depression was higher in the case group even after adjusting for other variables. CONCLUSIONS Our study underlined the remarkable prevalence of depression among HCV patients. Therefore, designing depression screening tests is suggested to help such patients before starting the treatment.
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Affiliation(s)
- Leila Kasraian
- Associate Professor, Community Medicine Specialist, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Shiraz, IR Iran
- Corresponding Author: Leila Kasraian, No 164 lane 37 Besat Boulevard, 7174715357 Shiraz, IR Iran. Tel: +98-9177157413, Fax: +98-7116264006, E-mail:
| | - Neda Negarestani
- Assistant Professor, Psychiatrist, Manager of Consultation Center, Iranian Blood Transfusion Research Center, Shiraz, IR Iran
| | - Mohammad Hossein Karimi
- PhD of Immunology, Director, President, Iranian Blood Transfusion Research Center, Shiraz Blood Transfusion Organization, Shiraz, IR Iran
| | - Sahar Dehbidi
- Master of Cellular and Molecular Science, Shiraz, IR Iran
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8
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Lin YM, Yu BC, Chiu WT, Sun HY, Chien YC, Su HC, Yen SY, Lai HW, Bai CH, Young KC, Tsao CW. Fluoxetine regulates cell growth inhibition of interferon-α. Int J Oncol 2016; 49:1746-54. [DOI: 10.3892/ijo.2016.3650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/25/2016] [Indexed: 11/05/2022] Open
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9
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Chereji E, Kern S, Fuller B, Morasco BJ, Phelps A, Hauser P. Co-occurring Depression, Chronic Pain and Substance Use Disorders in People with Hepatitis C. ACTA ACUST UNITED AC 2016. [DOI: 10.2174/1874220301603010079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic infection with Hepatitis C virus (HCV) is common and can result in serious and sometimes fatal liver complications. The impact of HCV on the liver can be further complicated by medical and psychological comorbidities. Depression, substance use, and pain syndromes are frequent co-morbid conditions in people with HCV and diminish functioning, quality of life, and treatment compliance. Understanding the underlying biological mechanisms of these comorbid conditions within the context of HCV may help elucidate factors contributing to their co-occurrence, perhaps mediatedviapro-inflammatory cytokines. The current review provides a synthesis of the literature on depression, substance use disorders and chronic pain in the presence of HCV. The review includes studies conducted with both veteran and civilian populations. The implications for assessment and antiviral treatment of HCV will be considered.
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10
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Hepgul N, Pariante CM, Baraldi S, Borsini A, Bufalino C, Russell A, Agarwal K, Cleare AJ, Forton DM, Henderson M, Mondelli V, Ranjith G, Hotopf M. Depression and anxiety in patients receiving interferon-alpha: The role of illness perceptions. J Health Psychol 2016; 23:1405-1414. [PMID: 27458106 DOI: 10.1177/1359105316658967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Development of psychiatric symptoms during interferon-alpha therapy may be influenced by psychological factors. We examined illness perceptions using the Revised Illness Perceptions Questionnaire in 55 patients with chronic hepatitis C virus infection, due to receive interferon-alpha. The Hospital Anxiety and Depression Scale was used to assess the development of symptoms. Negative identity, consequences and emotional representation beliefs were significantly associated with both higher depression and anxiety scores. Negative illness perceptions play a predictive role in the development of interferon-alpha-induced psychiatric symptoms.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Max Henderson
- 1 King's College London, UK.,2 King's College Hospital, UK
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11
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Dodd Z, Banga CA, Mason K, Meaney C, Leszcz M, Sockalingam S. Engagement in Group Psychotherapy Among Marginalized Individuals With Hepatitis C. Int J Group Psychother 2016; 66:338-360. [PMID: 38449126 DOI: 10.1080/00207284.2016.1149410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This article examines an innovative psychoeducational group model at a community-based hepatitis C treatment program in Toronto, Canada. Group support is increasingly used as part of community-based, interdisciplinary approaches to addressing the complex psychosocial needs and barriers to care of individuals living with and/or undergoing treatment for hepatitis C. This article articulates the theoretical framework and details of one such group model. It also examines group engagement and outcomes using data collected over three group cycles. Psychotherapeutic engagement was higher than might be anticipated for a highly marginalized population. Specifically, group cohesion measures were equivalent or higher compared to norms for other support/psychotherapy groups. This study suggests that individuals with complex psychosocial issues have the ability to engage meaningfully in group therapy.
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12
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Herold S, Freudenreich O. Hepatitis C Virus and Schizophrenia: Expanding the Role of the Community Psychiatrist. PSYCHOSOMATICS 2016; 57:634-637. [PMID: 27418108 DOI: 10.1016/j.psym.2016.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Sarah Herold
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Erich Lindemann Mental Health Center, Boston, MA.
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Erich Lindemann Mental Health Center, Boston, MA; Harvard Medical School, Boston, MA
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13
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Alterations in leukocyte transcriptional control pathway activity associated with major depressive disorder and antidepressant treatment. Transl Psychiatry 2016; 6:e821. [PMID: 27219347 PMCID: PMC5070063 DOI: 10.1038/tp.2016.79] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 03/23/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022] Open
Abstract
Major depressive disorder (MDD) is associated with a significantly elevated risk of developing serious medical illnesses such as cardiovascular disease, immune impairments, infection, dementia and premature death. Previous work has demonstrated immune dysregulation in subjects with MDD. Using genome-wide transcriptional profiling and promoter-based bioinformatic strategies, we assessed leukocyte transcription factor (TF) activity in leukocytes from 20 unmedicated MDD subjects versus 20 age-, sex- and ethnicity-matched healthy controls, before initiation of antidepressant therapy, and in 17 of the MDD subjects after 8 weeks of sertraline treatment. In leukocytes from unmedicated MDD subjects, bioinformatic analysis of transcription control pathway activity indicated an increased transcriptional activity of cAMP response element-binding/activating TF (CREB/ATF) and increased activity of TFs associated with cellular responses to oxidative stress (nuclear factor erythroid-derived 2-like 2, NFE2l2 or NRF2). Eight weeks of antidepressant therapy was associated with significant reductions in Hamilton Depression Rating Scale scores and reduced activity of NRF2, but not in CREB/ATF activity. Several other transcriptional regulation pathways, including the glucocorticoid receptor (GR), nuclear factor kappa-B cells (NF-κB), early growth response proteins 1-4 (EGR1-4) and interferon-responsive TFs, showed either no significant differences as a function of disease or treatment, or activities that were opposite to those previously hypothesized to be involved in the etiology of MDD or effective treatment. Our results suggest that CREB/ATF and NRF2 signaling may contribute to MDD by activating immune cell transcriptome dynamics that ultimately influence central nervous system (CNS) motivational and affective processes via circulating mediators.
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14
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MM B, A Y, U Y, GM SED, M A, H AG, E F, MM ES. Major depressive disorder and generalized anxiety disorder and response to treatment in hepatitis C patients in Egypt. Int J Psychiatry Med 2015; 50:147-62. [PMID: 26405268 DOI: 10.1177/0091217415605029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of the study was to estimate the prevalence and associated correlates of major depressive disorder and generalized anxiety disorder in hepatitis C virus patients before and after treatment and to investigate the relationship between major depressive disorder and generalized anxiety disorder and treatment response. METHODS A total of 116 consecutive hepatitis C virus patients from hepatitis C virus treatment center in Zagazig city, Egypt, were included in the study and divided into treated group (N = 58) and untreated group (N = 58). All hepatitis C virus patients were screened for major depressive disorder and generalized anxiety disorder using hospital anxiety and depression scale, and those who screened positive were interviewed to confirm the diagnosis of major depressive disorder and generalized anxiety disorder using DSM-IV-TR diagnostic criteria. These measures were done at baseline and after 12 weeks of treatment or observation. RESULTS At baseline, 3.5% and 12.1% of hepatitis C virus patients (treated group) had major depressive disorder and generalized anxiety disorder, respectively. After 12 weeks of treatment 37.9% of hepatitis C virus patients (treated group) had major depressive disorder and 46.6% had generalized anxiety disorder. There was a significant statistical difference between hospital anxiety and depression scale scores for depression (3.3 ± 2.3 vs. 6.4 ± 3.2, t = 9.6, p = 0.001) and for anxiety (4.6 ± 2.4 vs. 7.3 ± 3.0, t = 10.2, p = 0.001) before and after treatment. There was also significant statistical difference between treated group and untreated group regarding hospital anxiety and depression scale scores after treatment and observation (depression, treated group 6.4 ± 3.2 vs. untreated group 4.0 ± 2.4, t = 3.7, p = 0.001; anxiety, treated group 7.3 ± 3.0 vs. untreated group 4.5 ± 2.3, t = 4.4, p = 0.001). There was no association between major depressive disorder and generalized anxiety disorder and treatment response. CONCLUSIONS Major depressive disorder and generalized anxiety disorder are common in hepatitis C virus patients after treatment with interferon and ribavirin and were not related to treatment response.
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Affiliation(s)
- Bassiony MM
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
| | - Yousef A
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
| | - Youssef U
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
| | - Salah El-Deen GM
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
| | - Abdelghani M
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
| | - Al-Gohari H
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
| | - Fouad E
- Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
| | - El-Shafaey MM
- Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
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15
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Mason K, Dodd Z, Sockalingam S, Altenberg J, Meaney C, Millson P, Powis J. Beyond viral response: A prospective evaluation of a community-based, multi-disciplinary, peer-driven model of HCV treatment and support. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 26:1007-13. [PMID: 26005037 DOI: 10.1016/j.drugpo.2015.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/03/2015] [Accepted: 04/16/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the majority of new cases of hepatitis C (HCV) occur among people who inject drugs, very few receive treatment. In response, low-barrier, multidisciplinary models of HCV treatment have emerged in recent years to serve illicit drug users and have demonstrated comparable outcomes to the care delivered in tertiary care settings. However, few studies have measured comprehensive outcomes of these models. METHODS The Toronto Community Hep C Program (TCHCP) is a community-based partnership between three primary health care centres with integrated specialist support. Program clients were interviewed using standardized questionnaires at three time points (baseline, post completion of HCV support group, and one year post group completion). The primary outcome of this study was self-reported overall health. Secondary outcomes included mental health, substance use, housing and income stability, and access to health care. RESULTS TCHCP clients reported high rates of poverty, histories of trauma and incarceration. Physical and mental health co-morbidities were also very common; 78% reported having at least one chronic medical problem in addition to HCV and 41% had a lifetime history of hospitalization for mental health reasons. Participation in the program improved access to HCV care. Prior to joining the TCHCP, only 15% had been assessed by a HCV specialist. By the end of the study period this had increased significantly to 54%. Self-reported overall health did not improve during the study period. Housing status and income showed significant improvement. The proportion of participants with stable housing increased from 54% to 76% during the study period (p=0.0017) and the proportion of patients receiving income from provincial disability benefits also increased significantly (55% vs 75%, p=0.0216). CONCLUSION This study demonstrated that a multi-disciplinary, community-based model of HCV treatment improves participant's lives in ways that extend beyond hepatitis C.
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Affiliation(s)
- Kate Mason
- South Riverdale Community Health Centre, Toronto, Canada
| | - Zoë Dodd
- South Riverdale Community Health Centre, Toronto, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Canada; Medical Psychiatry Program, University Health Network, Toronto, Canada
| | | | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Peggy Millson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jeff Powis
- Department of Medicine, University of Toronto, Toronto, Canada; Toronto East General Hospital, Toronto, Canada.
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Whitehead NE, Hearn LE, Marsiske M, Kahn MR, Latimer WW. Awareness of biologically confirmed HCV among a community residing sample of drug users in Baltimore City. J Community Health 2014; 39:487-93. [PMID: 24173529 DOI: 10.1007/s10900-013-9782-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The present study sought to examine: (1) the prevalence and correlates of biologically confirmed Hepatitis C (HCV) and (2) the prevalence and correlates of prior HCV diagnosis and an unmet need for HCV treatment, among a community residing sample of drug users. The current study used a subset of HCV tested participants from the larger NEURO-HIV Epidemiologic Study from Baltimore, Maryland (M(age) = 34.81, SD = 9.25; 46% female). All participants were tested for HCV at baseline. Self-report was used to assess awareness of an HCV diagnosis and participation in treatment. Of the 782 participants tested for HCV, 19% reported having received an HCV diagnosis in the past while 48% tested positive for HCV. Only 6% reported having received treatment for any form of hepatitis. Of those who tested HCV positive, 63% reported never being diagnosed, and only 13% received any treatment for HCV. We found that only 35% of those who reported a prior HCV diagnosis received any treatment. The findings regarding lack of HCV awareness and diagnosis were considerable as expected. These deficits suggest that there are numerous gaps in patients' knowledge and beliefs regarding HCV that may interfere at multiple steps along the path from diagnosis to treatment. This study clearly demonstrates that a critical need exists to improve public knowledge of HCV risk factors, the need for testing, and the availability of effective treatment.
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Affiliation(s)
- Nicole Ennis Whitehead
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Room 3146, Gainesville, FL, 32611, USA,
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Fluoxetine a novel anti-hepatitis C virus agent via ROS-, JNK-, and PPARβ/γ-dependent pathways. Antiviral Res 2014; 110:158-67. [PMID: 25151487 DOI: 10.1016/j.antiviral.2014.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/10/2014] [Accepted: 08/02/2014] [Indexed: 02/06/2023]
Abstract
More than 20% of chronic hepatitis C (CHC) patients receiving interferon-alpha (IFN-α)-based anti-hepatitis C virus (HCV) therapy experienced significant depression, which was relieved by treatment with fluoxetine. However, whether and how fluoxetine affected directly the anti-HCV therapy remained unclear. Here, we demonstrated that fluoxetine inhibited HCV infection and blocked the production of reactive oxygen species (ROS) and lipid accumulation in Huh7.5 cells. Fluoxetine facilitated the IFN-α-mediated antiviral actions via activations of signal transducer and activator of transcription (STAT)-1 and c-Jun amino-terminal kinases (JNK). Alternatively, fluoxetine elevated peroxisome proliferator-activated receptor (PPAR) response element activity under HCV infection. The inhibitory effects of fluoxetine on HCV infection and lipid accumulation, but not production of ROS, were partially reversed by the PPAR-β, -γ, and JNK antagonists. Furthermore, fluoxetine intervention to the IFN-α-2b regimen facilitated to reduce HCV titer and alanine transaminase level for CHC patients. Therefore, fluoxetine intervention to the IFN-α-2b regimen improved the efficacy of anti-HCV treatment, which might be related to blockades of ROS generation and lipid accumulation and activation of host antiviral JNK/STAT-1 and PPARβ/γ signals.
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Longitudinal effects of selective serotonin reuptake inhibitor therapy and cytokine-related depression on hepatitis C viral logs during antiviral therapy. J Clin Psychopharmacol 2014; 34:80-4. [PMID: 24135839 DOI: 10.1097/jcp.0b013e3182a47397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to determine the longitudinal effects of selective serotonin reuptake inhibitor (SSRI) therapy and cytokine-related depression on levels of hepatitis C virus (HCV) during treatment with combination therapy. BACKGROUND Prior studies have investigated the association between cytokine-related depression and sustained virological response, but it is unknown whether anti-inflammatory properties of SSRIs used to treat cytokine-related depression inadvertently contravene proinflammatory properties of pegylated interferon (Peg-IFN), in effect reducing therapeutic efficacy. STUDY In a retrospective cohort design, patients being treated with Peg-IFN or interferon in combination with ribavirin at a gastroenterology clinic were followed from initiation of therapy until 24 weeks after the completion of therapy. Sustained virological response and rate of decline of HCV RNA levels were compared among patients with SSRI therapy and cytokine-related depression. RESULTS Selective serotonin reuptake inhibitor therapy and cytokine-related depression did not adversely impact the proportion of patients achieving sustained virological response. In a multivariate longitudinal analysis, the mean slope of HCV RNA levels declined faster over time in patients without cytokine-related depression in comparison to patients with cytokine-related depression (P = 0.05), and the mean slope of HCV RNA levels declined similarly over time in patients with and without SSRI therapy. CONCLUSIONS In this retrospective cohort, SSRI therapy did not interfere with immune activation dynamics of Peg-IFN/ribavirin, and patients without cytokine-related depression developed quicker responses and suppressed HCV replication more favorably over time.
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Serafini G, Pompili M, Elena Seretti M, Stefani H, Palermo M, Coryell W, Girardi P. The role of inflammatory cytokines in suicidal behavior: a systematic review. Eur Neuropsychopharmacol 2013; 23:1672-86. [PMID: 23896009 DOI: 10.1016/j.euroneuro.2013.06.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/01/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
Abstract
There is growing evidence that inflammatory mediators play a critical role in the pathophysiology of both major depression and suicidal behavior. Immunological differences have been reported in both major affective disorders and suicidal behavior. Specifically, increased levels of pro-inflammatory cytokines have been shown to correlate with the severity of depression and various cytokines have been identified as potentially important in understanding the pathophysiology of major affective disorders/suicidality. We aimed to conduct a systematic review of the current literature to investigate the association between inflammatory cytokines and suicidal behavior. Only articles from peer-reviewed journals were selected for inclusion in the present review. Most studies documented the association between suicidality and IL2, IL-6, IL-8, TNF-α and VEGF levels that have been found altered in suicidal behavior. The presence of major depressive disorder (MDD) with suicidal ideation/attempts was associated with differences in inflammatory cytokine profile when compared to that without suicidal ideation/attempts. Most suicide attempters or subjects with suicidal ideation showed an imbalance of the immune system but this does not imply the existence of a causal link. Also, not all studies demonstrated a positive correlation between inflammatory cytokines and suicidal behavior. Further additional studies should elucidate the molecular mechanisms of the immune activation pathways underlying suicidality.
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Affiliation(s)
- Gianluca Serafini
- Department of Neurosciences, Mental Health and Sensory Organs-Suicide Prevention Center, Sapienza University of Rome, Sant'Andrea Hospital, 1035-1039 Via di Grottarossa, Rome 00189, Italy.
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Wang Z, Du J, Zhao M, Page K, Xiao Z, Mandel JS. Hepatitis C virus infection is independently associated with depression among methadone maintenance treatment heroin users in China. Asia Pac Psychiatry 2013; 5:191-6. [PMID: 23857926 PMCID: PMC4513657 DOI: 10.1111/j.1758-5872.2012.00209.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 04/15/2012] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Depression and hepatitis C virus (HCV) infection are two common conditions among heroin users in methadone maintenance treatment (MMT). However, the comorbid relationship between depression and HCV infection among MMT patients is not well understood. METHODS One hundred and fifteen MMT patients were recruited from the Yangpu MMT Clinic in Shanghai. Demographic characteristics, drug use and HCV-related information were collected using a structured interview. The Beck Depression Inventory (BDI-II) and the Perceived Stress Scale (PSS) were administered to evaluate participants' symptoms of depression and stress severity. HCV antibody (anti-HCV) test results were collected from patients' MMT clinical medical records. RESULTS 58.2% of participants were anti-HCV positive, and 41.3% scored moderate-to-severe for symptoms of depression (BDI-II scores >19). The prevalence of depressive symptoms (BDI-II score >19) was greater in HCV positive than HCV negative participants (51.6% versus 27.7%, respectively; P = 0.02). There was no significant difference in the perceived stress level by anti-HCV status; overall, the perceived stress level score was 15.9 ± 5.7. In logistic regression analysis, positive anti-HCV status (OR = 3.75, 95% CI = 1.42-9.90), and greater perceived stress (OR = 1.23, 95% CI = 1.11-1.36) were independently associated with depression, after controlling for gender, age, duration of drug use and the awareness of HCV infection. DISCUSSION Depression and HCV infection are common and co-occurring among MMT patients in Shanghai. HCV infection itself appears to be associated with depressive symptoms regardless of whether the individual is aware of his HCV infection status. This finding indicates that it is important to consider the impact of depressive symptoms on injection risk behaviors and HCV transmission when planning intervention programs in MMT clinics.
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Affiliation(s)
- Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Sockalingam S, Tseng A, Giguere P, Wong D. Psychiatric treatment considerations with direct acting antivirals in hepatitis C. BMC Gastroenterol 2013; 13:86. [PMID: 23672254 PMCID: PMC3658966 DOI: 10.1186/1471-230x-13-86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 05/04/2013] [Indexed: 01/22/2023] Open
Abstract
Background Despite recent advances in hepatitis C (HCV) treatment, specifically the addition of direct acting antivirals (DAAs), pegylated interferon-alpha remains the backbone of HCV therapy. Therefore, the impact of DAAs on the management of co-morbid psychiatric illness and neuropsychiatric sequalae remains an ongoing concern during HCV therapy. This paper provides a review of the neuropsychiatric adverse effects of DAAs and drug-drug interactions (DDIs) between DAAs and psychiatric medications. Methods We conducted a Pubmed search using relevant search terms and hand searched reference lists of related review articles. In addition, we searched abstracts for major hepatology conferences and contacted respective pharmaceutical companies for additional studies. Results Limited data is available on the neuropsychiatric adverse effects of DAAs; however, data from major clinical trials suggest that DAAs have minimal neuropsychiatric risk. DAAs can potentially interact with a variety of psychotropic agents via cytochrome P450 and p-glycoprotein interactions. Triazolam, oral midazolam, St. John’s Wort, carbamazepine and pimozide, are contraindicated with DAAs. DDIs between DAAs and antidepressants, anxiolytics, hypnotics, mood stabilizers, antipsychotics and treatments for opioid dependence are summarized. Conclusions Although DAAs do not add significant neuropsychiatric risk, the potential for DDIs is high. Consideration of DDIs is paramount to improving medication adherence and mitigating adverse effects during HCV therapy.
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Affiliation(s)
- Sanjeev Sockalingam
- University Health Network, Program in Medical Psychiatry, Toronto General Hospital, 200 Elizabeth Street 8EN-228, Toronto, ON M5G 2C4, Canada.
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Utilizing genomic polymorphisms to personalize hepatitis C therapies. Curr Opin Organ Transplant 2013; 17:198-203. [PMID: 22414802 DOI: 10.1097/mot.0b013e328351093b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW The need for liver transplant due to the progression of hepatitis C virus (HCV) infection necessitates the consideration of antiviral treatment. Host genomic variations affect response to HCV treatment and predict the rates of adverse effects. Recently, multiple genomic polymorphisms were found to be critical in predicting treatment response as well as the rate of neuropsychiatric adverse effects in patients infected with HCV who are receiving antiviral treatments. RECENT FINDINGS The use of antiviral treatments (pegylated IFN-alpha and ribavirin) to clear HCV infection is associated with poor response in HCV genotype 1 and with the development of depression. Polymorphisms in the promoter region of the IFN-alpha/beta receptor 1 (IFNAR1) can influence the risk of developing depression. Similar polymorphisms in the IL28B gene encoding for IFN-λ-3 are associated with a two- to three-fold improvement in response to treatment. SUMMARY In patients with HCV infection receiving antiviral treatments, genomic variations in two genes can help predict the increased risk of developing depression and the likelihood of achieving virus clearance. This can identify patients who are at an increased likelihood of virus clearance and who should be targeted to receive prophylactic approaches (antidepressants, psychotropics) to prevent the development of depression during HCV antiviral treatment.
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Sims OT, Whalen CC, Nackerud LG, Bride BE. Birth cohort testing for hepatitis C virus: implications for clinical social workers in health care settings. SOCIAL WORK IN HEALTH CARE 2013; 52:689-703. [PMID: 24028735 DOI: 10.1080/00981389.2013.806385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Centers for Disease Control and Prevention recommends one-time hepatitis C virus (HCV) testing for baby boomers born between 1945-1965 in the United States. This public health initiative is known as birth cohort (baby boomer) testing for HCV. The intent of birth cohort testing is to identify and mobilize undiagnosed HCV-infected persons into care and treatment. Subsequently, clinical social workers in health care settings can anticipate a substantial increase in the number of HCV-infected persons presenting for care and treatment. The purpose of this article is to inform clinical social workers in health care settings of HCV, the standard of care and treatment for HCV, and clinical dilemmas associated with HCV patient care. Epidemiology and natural history of HCV, the standard of care and treatment for HCV, and etiology and management of neuropsychiatric adverse effects associated with patient care are discussed.
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Affiliation(s)
- Omar T Sims
- a School of Social Work , University of Alabama , Tuscaloosa , Alabama , USA
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Daw MA, Dau AA, Agnan MM. Influence of healthcare-associated factors on the efficacy of hepatitis C therapy. ScientificWorldJournal 2012; 2012:580216. [PMID: 23346018 PMCID: PMC3543794 DOI: 10.1100/2012/580216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/25/2012] [Indexed: 02/07/2023] Open
Abstract
Hepatitis C infection is a complex entity associated with sizable morbidity and mortality, with great social and economic consequences that put a heavy potential burden on healthcare systems allover the world. Despite the great improvement of hepatitis C virus (HCV) therapy and its high clinical efficacy, major influencing factors are still hindering and diminishing the effectiveness of hepatitis C treatment. This minimizes the quality of life of the infected patients and reduces the outcome of such therapy, particularly in certain groups of patients such as intravenous drug users and patients coinfected with human immune deficiency virus (HIV). A variety of factors were evolved either at patient individual level, healthcare providers, community surrounding levels, or healthcare setting systems. Analyzing and understanding these factors could help to improve HCV interventions and, thus, reduce the burden of such infection. The objectives of this paper were to highlight such factors and outline the holistic approaches that could be used to overcome such factors.
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Affiliation(s)
- Mohamed A Daw
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Tripoli CC 82664, Libya.
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Rudorfer MV, Hillefors M. Assessing Psychiatric Adverse Effects during Clinical Drug Development. Pharmaceut Med 2012. [DOI: 10.1007/bf03262382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Feld JJ. Treatment indication and response to standard of care with peginterferon and ribavirin in acute and chronic HCV infection. Best Pract Res Clin Gastroenterol 2012. [PMID: 23199502 DOI: 10.1016/j.bpg.2012.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Great strides have been made in the treatment of hepatitis C virus (HCV) infection in the past decade. Although there is much focus on the development of new direct-acting antivirals (DAA), interferon and ribavirin remain the backbone of therapy for both acute and chronic HCV infections. While DAA therapy will likely eventually largely replace interferon, in much of the world and for genotype non-1 patients, peginterferon and ribavirin remain first-line therapy. Interferon-based therapy is highly effective in acute HCV with high response rates with short courses of therapy. Unfortunately once infection progresses to chronicity, treatment success rates drop off considerably. The indications, pre-treatment evaluation and efficacy of peginterferon and ribavirin therapy in the treatment of acute and chronic HCV infection are discussed with strategies to improve outcomes and manage adverse events.
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Affiliation(s)
- Jordan J Feld
- Toronto Western Hospital Liver Centre, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada.
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Abstract
Despite its efficacy in treating hepatitis C, interferon-α (IFN-α) can cause depression. The purpose of this systematic review is to summarize and discuss the available and effective therapies in treating IFN-α-induced depression. Using PubMed, The Cochrane Library, Scopus, Embase, Ovid of Medline, PsycINFO, and ISI Web of Knowledge, we selected 64 articles concerning IFN-α-induced depression treatment in hepatitis C patients. Selective serotonin reuptake inhibitors can be considered the first choice for the treatment of IFN-α-induced depression, as demonstrated in open-label studies, case reports, and a randomized, double-blind, placebo-controlled trial. Also 5-hydroxytryptophan and tryptophan have been suggested to be effective as monotherapy or as augmentation of selective serotonin reuptake inhibitors. Clinical cases that show positive effects of tricyclic antidepressants, however, do not provide sufficient evidence for the use of these drugs. Two cohort studies have reported the effectiveness of amisulpride, but not of levosulpiride. Mirtazapine has been suggested to be a better choice of treatment in cases where insomnia or anorexia develop. Milnacipram can be useful in cases of concomitant medications, for the unlikely occurrence of drug-drug interactions. Psychostimulants represent an empirical treatment without controlled data to support their use. Two case reports have shown the favorable use of bupropion, particularly if sexual dysfunction or cravings for illicit drugs are present. A single case report suggests electroconvulsive therapy to be a possible choice when antidepressants are ineffective or poorly tolerated. The main limitation of our review is that the quality of the findings varied across the reviewed studies. Our observations may help clinicians with managing IFN-α-induced depression.
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Tsao CW, Lin CF, Wu HT, Ma CT, Huang WC, Hsieh CY, Choi PC, Young KC. Glycogen synthase kinase-3β is critical for Interferon-α-induced serotonin uptake in human Jurkat T cells. J Cell Physiol 2012; 227:2556-66. [DOI: 10.1002/jcp.22994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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García-Toro M, Vilella A, Gili M, Salva J, Roca M. Hepatitis C treatment and erotomania. Gen Hosp Psychiatry 2012; 34:103.e7-103.e10. [PMID: 22018768 DOI: 10.1016/j.genhosppsych.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 09/12/2011] [Accepted: 09/13/2011] [Indexed: 10/16/2022]
Abstract
The emergence of psychosis during antiviral therapy for hepatitis C is a rare side effect poorly understood in terms of etiopathogenesis, clinical features and prognosis. Erotomania is a rare psychotic syndrome characterized by the presence of a delusion: the patient (usually a female) is loved by a specific man. We present a patient who began a clinical picture of erotomania that involved his doctor a few days after treatment of interferon and ribavirin was started. He stalked his doctor, forcing the police and the court to intervene. Nevertheless, once antipsychotic treatment was established, symptoms remitted, and the patient continued antiviral treatment successfully.
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Affiliation(s)
- Mauro García-Toro
- Servicio de Psiquiatría, Hospital Son Llatzer, 07198 Palma de Mallorca, Universitat de les Illes Balears (UIB), Red de Investigación en, Actividades Preventivas y Promoción de la Salud (redIAPP), Spain.
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Su HC, Ma CT, Lin CF, Wu HT, Chuang YH, Chen LJ, Tsao CW. The acid sphingomyelinase inhibitors block interferon-α-induced serotonin uptake via a COX-2/Akt/ERK/STAT-dependent pathway in T cells. Int Immunopharmacol 2011; 11:1823-31. [DOI: 10.1016/j.intimp.2011.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/30/2011] [Accepted: 07/15/2011] [Indexed: 12/29/2022]
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García-Toro M, Vilella Martorell A, Carral Martínez M, Jimeno Beltrán T, Román Ruiz del Moral Y, Pradas Guerrero C, Gili Planas M, Roca Bennasar M. [Use of anxiolytics and antidepressants before and after treatment with interferon-alpha and ribavirin in patients with hepatitis C]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:307-308. [PMID: 21376422 DOI: 10.1016/j.gastrohep.2010.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 11/02/2010] [Indexed: 05/30/2023]
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Fragoso YD, Frota ERC, Lopes JS, Noal JS, Giacomo MC, Gomes S, Gonçalves MVM, da Gama PD, Finkelsztejn A. Severe depression, suicide attempts, and ideation during the use of interferon beta by patients with multiple sclerosis. Clin Neuropharmacol 2011; 33:312-6. [PMID: 21079457 DOI: 10.1097/wnf.0b013e3181f8d513] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Interferon (IFN) beta is a safe and efficient drug for treating multiple sclerosis (MS). It is widely accepted that previously depressed patients may get worse when using IFN-beta. There are few reports on the association of IFN-beta and severe depression among patients without previous psychiatric history. METHODS Discussion of a case of a patient with MS who developed severe depression and attempted suicide while using IFN-beta encouraged us to review the subject. A group of neurologists in Brazil retrospectively gathered together their similar cases for the present paper. RESULTS The present paper reports on 11 cases of severe depression with suicide attempts or ideation among patients with MS who were using IFN-beta. These patients had no previous history of any psychiatric disease. Nine patients developed the symptoms over a relatively short period (4 months, on average). Two patients developed severe depression after more than 1 year of treatment with IFN-beta. Phobic, aggressive, behavioral, psychotic, and manic symptoms also were observed in these patients, thus suggesting the existence of a complex mood-behavior disorder associated with this drug. Interferon beta withdrawal led to complete remission of symptoms. The Naranjo algorithm established a highly probable association between IFN-beta and this adverse reaction in these patients. CONCLUSIONS Although uncommon, severe depression with suicide ideation or attempts may be observed during treatment of MS with IFN-beta. This association should not discourage the use of this drug, but physicians need to be aware of this possible adverse event from IFN-beta.
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Ramsey SE, Engler PA, Stein MD, Brown RA, Cioe P, Kahler CW, Promrat K, Rose J, Anthony J, Solomon DA. Effect of CBT on Depressive Symptoms in Methadone Maintenance Patients Undergoing Treatment for Hepatitis C. ACTA ACUST UNITED AC 2011; 2:2-10. [PMID: 21743837 DOI: 10.4172/2155-6105.1000109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To examine the efficacy of a cognitive-behavioral intervention (CBT) to prevent depression among methadone maintenance patients undergoing antiviral treatment for hepatitis C (HCV), 29 patients beginning HCV treatment were randomized to CBT or standard care (SC). Study participants did not meet criteria for major depressive disorder at the time of study recruitment. CBT did not result in less depression-related antiviral treatment failure, better adherence to antiviral treatment, or better HCV RNA outcomes. There were no significant treatment group differences on depressive symptoms over time. The CBT group did display a greater and more consistent decline in both BDI-II and HAM-D scores over time (d=.85 on the BDI-II; d=.72 on the HAM-D).
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Affiliation(s)
- Susan E Ramsey
- The Warren Alpert Medical School of Brown University, USA
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Abstract
Hepatitis C is one of the leading causes of liver disease in the United States, affecting more than 4 million individuals. The current treatment regimen involves pegylated interferon in combination with ribavirin. Although antiviral treatment has been associated with a greater than 50% sustained viral response rate, the adverse effects have proven to be detrimental to quality of life and therapy adherence, and consequently lead to lower sustained viral response rates. This article identifies the most frequently described complications associated with pegylated interferon and ribavirin. The active management of these complications is discussed, including both preventive and empiric treatments.
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Affiliation(s)
- Hubert Sung
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA USA
| | - Michael Chang
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Sammy Saab
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
- Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 USA
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Galvão-de Almeida A, Quarantini LC, Batista-Neves S, Lyra AC, Paraná R, de Oliveira IR, Miranda-Scippa A, Guindalini C. Is the interferon-α-triggered depressive episode a self-limited kind of depression? Four cases of persistent affective symptoms after antiviral treatment in HCV-infected individuals. World J Biol Psychiatry 2010; 11:914-8. [PMID: 20642400 DOI: 10.3109/15622975.2010.504282] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To discuss relevant aspects in a series of cases in which interferon-α-triggered depressive symptoms persisted up to 4 years after therapy cessation in HCV-infected patients. METHODS Two experienced psychiatrists (AGA and LCQ) identified these four cases in a systematic evaluation program of HCV patients in the Hepatology Unit of the Teaching Hospital at the Federal University of Bahia, Brazil. Lifetime psychiatric diagnoses were confirmed by the Mini International Neuropsychiatric Interview (MINI Plus), and a questionnaire was submitted in order to gather clinical and sociodemographic characteristics. RESULTS In three out of the four cases identified, major depression diagnosis was reached after more than 12 months of interferon-α therapy interruption and, in one case, depression recurred 6 months after antiviral treatment cessation in a patient on antidepressants. The only case that referred a past history of psychiatric diagnosis reported no offer of mental health care despite the presence of a major depressive episode with psychotic features and suicidal behaviour during the cytokine usage. CONCLUSIONS Interferon-α-triggered depression may remain undiagnosed even in tertiary university hospitals, may persist years after the antiviral therapy cessation, and may recur even in patients on adequate antidepressant treatment.
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Affiliation(s)
- Amanda Galvão-de Almeida
- Department of Neurosciences and Mental Health, Universidade Federal da Bahia, Teaching Hospital - Psychiatry Service, Bahia, Brazil.
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Abstract
The combination of pegylated-interferon (PEG-IFN)/ribavirin is currently the standard of care antiviral treatment for chronic hepatitis C (CHC), but optimal results require an individual approach. Key issues are to deliver doses that confer optimal antiviral efficacy against hepatitis C virus (HCV) for a time sufficient to minimise relapse. Viral monitoring during therapy guides the subsequent treatment course, particularly HCV RNA results at 4 weeks (rapid viral response [RVR]) and 12 weeks (complete early viral response [cEVR]). There is strong evidence that for most patients with genotypes 2 or 3 HCV infection, RVR allows truncation of treatment to 16 weeks, provided ribavirin dose is weight-based. However, those patients with cirrhosis, insulin resistance/diabetes or older than 50 years need 6-12 months treatment. For "difficult-to-treat" CHC (genotypes 1 and 4), RVR is infrequent (approximately 15% in European studies), but allows treatment to be truncated from 48 to 24 weeks. Without RVR, there is some evidence that longer treatment (72 weeks) improves sustained viral response (SVR). However, "induction dosing" first 12 weeks of PEG-IFN clearly does not improve SVR. To prevent dose reductions and complete therapy, it is critical to detect and treat depression and other disabling side-effects, including judicious use of growth factors for severe anemia or neutropenia and possibly, thrombocytopenia. Another potentially important aspect may be attempts to counter central obesity and insulin resistance, which confer suboptimal antiviral response with any HCV genotype. Treatment partnerships with specialist nurses, psychological therapists and other healthcare workers are also essential for optimal individual management of patients with CHC.
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Affiliation(s)
- Narci C Teoh
- Gastroenterology and Hepatology Unit, Australian National University Medical School, Canberra Hospital, Garran, Australian Capital Territory, Australia.
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Abstract
Hepatitis C virus (HCV) affects about 170 million people worldwide and is the most common chronic blood borne infection in the United States. Since the advent of blood screening protocols in the early 1990s, injection drug use has become the leading cause of infection. Hepatitis C can have both hepatic and nonhepatic manifestations of infection. Hepatic manifestations include hepatic fibrosis, cirrhosis, liver cancer, and liver failure. The standard treatment for chronic HCV is combination therapy with pegylated interferon-α and ribavirin. Although pegylated interferon and ribavirin has been used against HCV for close to a decade, advances in therapy have centered on doses and treatment durations. There has been increasing interest in applying on-treatment response or viral kinetics to predict antiviral response rates and shape therapeutic intervention. Protease inhibitors are a promising adjuvant to combination therapy, but their efficacy and safety are still under investigation.
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Abstract
Depression and other influences on mental health can impact antiviral response rates during chronic hepatitis C treatment, the quality of life for these patients, and the risk for adverse outcomes such as suicide. Enhanced treatment outcomes for patients who are receiving interferon-α requires 1) addressing preexisting mental health problems, 2) alleviating psychiatric conditions that emerge during treatment, and 3) prediction and prevention of these conditions. Accumulating evidence indicates that these three goals are feasible. Collaborative involvement of psychiatric management may often be critical in this regard.
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Mikocka-Walus AA. Treatment of psychological co-morbidities in common gastrointestinal and hepatologic disorders. World J Gastrointest Pharmacol Ther 2010; 1:64-71. [PMID: 21577298 PMCID: PMC3091146 DOI: 10.4292/wjgpt.v1.i2.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 01/20/2010] [Accepted: 01/27/2010] [Indexed: 02/06/2023] Open
Abstract
Anxiety and depressive disorders frequently coexist with gastrointestinal and hepatologic conditions. Despite their high prevalence, approach to treating these co-morbidities is not always straightforward. This paper aims to review the current literature into etiology of psychological co-morbidities and their treatment in three conditions commonly encountered at gastroenterology outpatient clinics, namely inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and chronic hepatitis C (HepC). The paper demonstrates that although psychotherapy (and cognitive-behavioural therapy in particular) has been established as an effective treatment in IBS, more studies are needed in HepC and IBD. Antidepressants have been recognized as an effective treatment for psychological and somatic symptoms in IBS and for depression in HepC, but good quality studies in IBD are lacking despite the promising preliminary findings from animal models and case studies. Further studies in this area are needed.
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Affiliation(s)
- Antonina A Mikocka-Walus
- Antonina A Mikocka-Walus, School of Nursing and Midwifery,University of South Australia, Adelaide 5001, SA, Australia; School of Psychology, University of Adelaide, Adelaide 5005, SA, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
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