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Ekmen N, Can G, Can H. Preliminary examination of the relations between disease stage, illness perceptions, coping strategies, and psychological morbidity in chronic hepatitis B and C guided by the Common-Sense Model of Illness. Eur J Gastroenterol Hepatol 2021; 33:932-939. [PMID: 33867448 DOI: 10.1097/meg.0000000000002131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Chronic viral hepatitis (CVH) has a spectrum from asymptomatic disease to cirrhosis and hepatocellular carcinoma. In our study, we aimed to establish the relations between disease stage, illness perception, coping strategies and psychological morbidity in CVH. METHODS A total of 182 patients with chronic hepatitis B (CHB) (n = 136) and chronic hepatitis C (CHC) (n = 46) were enrolled. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire. Coping strategies were measured with the Carver Brief Coping Questionnaire. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Relations were evaluated by structural equation modeling (SEM). RESULTS In CHB, combining the questionnaire data using SEM resulted in a final model with an excellent fit [χ2 (2) = 0.00, P = 1.000, χ2/N = 0.00, root mean square error of approximation (RMSEA) < 0.001, comparative fit index (CFI) = 1.000, goodness-of-fit index (GFI) = 1.000]. Disease stage had a significant direct influence on illness perceptions (β = 0.23, P = 0.006). Illness perceptions had a significant direct influence on emotional coping strategy, depression and anxiety (β = 0.20, P = 0.019; β = 0.33, P < 0.001; β = 0.59, P < 0.001, respectively). While the use of emotional coping strategies was associated significantly (P = 0.01) with the presence of anxiety, problem-focused coping strategy was associated with depression (P = 0.004). In CHC, SEM resulted in a final model with an excellent fit [χ2 (2) = 0.078, P = 0.962, χ2/N = 0.039, RMSEA<0.001, CFI = 1.000, GFI = 0.999]. Disease stage did not have a significant direct influence on illness perceptions (P > 0.05). Illness perceptions had a significant direct influence on depression and anxiety (β = 0.27, P = 0.023; β = 0.44, P < 0.001, respectively). CONCLUSION The psychological consequences of the disease vary depending on the person's perception of illness and coping strategies.
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Affiliation(s)
- Nergiz Ekmen
- Department of Gastroenterology, Faculty of Medicine, Gazi University, Ankara
| | - Güray Can
- Department of Gastroenterology, Faculty of Medicine, Abant İzzet Baysal University, Bolu
| | - Hatice Can
- Department of Nephrology, Faculty of Medicine, İnönü University, Malatya, Turkey
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Psychological, Cognitive, and Laboratory Characteristics of End-Stage Liver Disease Patients. HEPATITIS MONTHLY 2020. [DOI: 10.5812/hepatmon.96433] [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: End-Stage Liver Disease (ESLD) causes several clinical and psychological comorbidities. Some accompanying psychiatric disturbances have significant effects on the patients’ quality of life. Objectives: Thus, we aimed to evaluate some psychological characteristics of ESLD patients. Methods: A cross-sectional study was conducted on 91 ESLD patients aged 18 - 70 years. We assessed the patients using the California Verbal Learning Test (CVLT), Fatigue Severity Scale, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Also, we measured the demographic and some laboratory data of the participants. The data were analyzed by SPSS version 21 software, and P values of less than 0.05 were considered significant. Results: The study included 68 men and 23 women with a mean age of 41.9 ± 13.72 years (range 19 - 68). The mean scores of fatigue (40.6 ± 14.8) and anxiety (12.98 ± 2.76) were more than the normal range. The most significant association was seen between age and CVLT items (attention (P = 0.01), immediate memory (P < 0.001), short delay free recall (0.01), and short delay cued recall (0.03). Conclusions: End-stage liver disease patients had anxiety, fatigue, and memory disorders in addition to their poor clinical conditions. Although the main treatment of ESLD is liver transplantation but the psychological and cognitive problems before transplantation in these patients are prognostic factors for post-operation compliance and follow up.
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Méndez-López M, Méndez M, Arias J, Arias JL. Effects of a high protein diet on cognition and brain metabolism in cirrhotic rats. Physiol Behav 2015; 149:220-8. [PMID: 26048304 DOI: 10.1016/j.physbeh.2015.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 12/12/2022]
Abstract
Hepatic encephalopathy (HE) is a neurological complication observed in patients with liver disease. Patients who suffer from HE present neuropsychiatric, neuromuscular and behavioral symptoms. Animal models proposed to study HE resulting from cirrhosis mimic the clinical characteristics of cirrhosis and portal hypertension, and require the administration of hepatotoxins such as thioacetamide (TAA). The aim of this study was to assess the effects of a high protein diet on motor function, anxiety and memory processes in a model of cirrhosis induced by TAA administration. In addition, we used cytochrome c-oxidase (COx) histochemistry to assess the metabolic activity of the limbic system regions. Male rats were distributed into groups: control, animals with cirrhosis, Control rats receiving a high protein diet, and animals with cirrhosis receiving a high protein diet. Results showed preserved motor function and normal anxiety levels in all the groups. The animals with cirrhosis showed an impairment in active avoidance behavior and spatial memory, regardless of the diet they received. However, the animals with cirrhosis and a high protein diet showed longer escape latencies on the spatial memory task. The model of cirrhosis presented an under-activation of the dentate gyrus and CA3 hippocampal subfields and the medial part of the medial mammillary nucleus. The results suggest that a high protein intake worsens spatial memory deficits shown by the TAA-induced model of cirrhosis. However, high protein ingestion has no influence on the COx hypoactivity associated with the model.
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Affiliation(s)
- M Méndez-López
- Department of Psychology, University of Zaragoza, Campus Ciudad Escolar s/n., 44003 Teruel, Spain.
| | - M Méndez
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, Plaza Feijóo s/n., 33003 Oviedo, Spain.
| | - J Arias
- Faculty of Medicine, Complutense University of Madrid, Ciudad Universitaria s/n., 28040 Madrid, Spain.
| | - J L Arias
- Laboratory of Neuroscience, Department of Psychology, Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo, Plaza Feijóo s/n., 33003 Oviedo, Spain.
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Hou LJ, Wang HW, Wei XX, Duan SP, Zhuo Y, Song XW, Shen BS. Urinary metabonomics for diagnosis of depression in hepatitis B virus-infected patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e27359. [PMID: 26023351 PMCID: PMC4443390 DOI: 10.5812/ircmj.17(4)2015.27359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression is concomitantly presented in Hepatitis B Virus (HBV)-infected patients and decreases these patients' quality of life. However, there are no laboratory-based methods to objectively diagnose this disorder. OBJECTIVES The aim of this study was to investigate the alteration of urinary metabolites in depressed HBV-infected patients. PATIENTS AND METHODS In this study, 81 depressed HBV-infected patients, 68 non-depressed HBV-infected patients and 64 Healthy Controls (HC) were recruited. A nuclear magnetic resonance (NMR)-based urinary metabonomic method was used to characterize the urinary metabolic profiling of depressed and non-depressed subjects. RESULTS Seventeen differential urinary metabolites responsible for discriminating depressed HBV-infected patients from non-depressed HBV-infected patients and HC were identified. Among these metabolites, pyruvate, isobutyrate, N-methylnicotinamide, α-hydroxybutyrate, acetoacetate and malonate were identified as potential biomarkers for diagnosing depression in HBV-infected patients. A combined panel of these potential biomarkers could effectively discriminate depressed HBV-infected patients from non-depressed HBV-infected patients and HC, with an average accuracy of 89.6% in the training set and a predictive accuracy of 86.4% in the test set. CONCLUSIONS These findings suggest that NMR-based urinary metabonomics approach might be a useful tool for the clinical diagnosis of depression in HBV-infected patients and the six potential biomarkers could be helpful for developing an objective diagnostic method. Limited by the number of recruited subjects, future studies are required to validate our conclusions.
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Affiliation(s)
- Li-Juan Hou
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Hong-Wei Wang
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiao-Xia Wei
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Shu-Peng Duan
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Ya Zhuo
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xin-Wen Song
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Bao-Sheng Shen
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
- Corresponding Author: Bao-Sheng Shen, Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China. Tel: +86-3733029485, Fax: +86-3733029645, E-mail:
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Abstract
This descriptive cross-sectional study was designed to determine the depression and anxiety levels, and their effects, on quality of life of patients with chronic Hepatitis B. Chronic infection with Hepatitis B virus has a profound effect on health-related quality of life. Medications, including interferon, that are commonly used to treat chronic viral Hepatitis B may cause depression as an adverse effect. However, little is known about the impact of depression and anxiety on quality of life in patients with Hepatitis B. A total of 96 patients aged between 15 and 61 years were included in the study. Slightly more than half of them (52%) were female. Three scales-the Beck Depression Inventory, Beck Anxiety Scale, and Short Form of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF)-were used in the study. The scores obtained from the BDS in 91.7% of the patients were above the cutoff value of 17. Moreover, 80 patients received interferon. There was a negative correlation between the physical, environmental, and cultural areas on the Beck Anxiety Scale and WHOQOL-BREF (Turkish) (p< .05). A high level of depressive symptoms was established in this study, and the physical, environmental, and cultural aspects of quality of life were determined to increase as the anxiety level increased.
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Campanholo KR, Romão MA, Machado MDAR, Serrao VT, Coutinho DGC, Benute GRG, Miotto EC, de Lucia MCS. Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test. Dement Neuropsychol 2014; 8:26-31. [PMID: 29213876 PMCID: PMC5619445 DOI: 10.1590/s1980-57642014dn81000005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely
used in clinical practice and research. The aim of this study was to provide
normative data for the adult Brazilian population and to study the influence
of gender, age and education on the TMT parts A and B, and ST cards A, B and
C. Methods We recruited 1447 healthy subjects aged ≥18 years with an educational
level of 0-25 years who were native speakers of Portuguese (Brazilian). The
subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of
the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST
A, B and C. Results Among the participants, mean intellectual efficiency was 103.20 (SD: 12.0),
age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were
significant differences between genders on the TMTA (p=0.002), TMTB
(p=0.017) and STC (p=0.024). Age showed a positive correlation with all
attention tests, whereas education showed a negative correlation. Gender was
not found to be significant on the multiple linear regression model, but age
and education maintained their interference. Conclusion Gender did not have the major impact on attentional tasks observed for age
and education, both of which should be considered in the stratification of
normative samples.
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Affiliation(s)
| | - Marcos Antunes Romão
- Psychology Division - Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | | | - Valéria Trunkl Serrao
- Psychology Division - Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | | | | | - Eliane Correa Miotto
- Neurology Department - Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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Torres DS, Abrantes J, Brandão‐Mello CE. Cognitive assessment of patients with minimal hepatic encephalopathy in Brazil. Metab Brain Dis 2013; 28:473-83. [PMID: 23625323 PMCID: PMC3734603 DOI: 10.1007/s11011-013-9405-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/04/2013] [Indexed: 01/16/2023]
Abstract
Minimal hepatic encephalopathy is a syndrome caused by liver cirrhosis and accompanied by a broad spectrum of cognitive symptoms. The objective of the present study was to describe the prevalence of minimal hepatic encephalopathy in cirrhotic patients and to compare their cognitive performance with controls using standardized tests. Patients receiving medication or experiencing comorbidities associated with cognitive disorders were excluded. The final cohort was compared with a control-matched group using the Mini-Mental State Examination (MMSE), as well as Simple Drawing, Clock Drawing, Rey Auditory-Verbal Learning Test (RAVLT), Random Letter, Stroop, Trail-Making Test (TMT) A and B, Boston Naming, Category Verbal Fluency, Digit Span, Constructional Praxis, Processing Speed, and Similarities Tests. The results indicated no differences in the prevalence of cognitive complaints spontaneously reported by 29 patients with cirrhosis versus 22 healthy controls. The most affected tests included: MMSE (26.3 ± 2 vs. 28.1 ± 1.8 points; p = 0.004), learning (35.4 ± 9 vs. 41 ± 9.1 points; p = 0.041), retroactive interference (0.67 ± 0.22 vs. 0.84 ± 0.16 points; p = 0.004), and recognition (8.7 ± 2.6 vs. 11.2 ± 4.1 points; p = 0.024) in RAVLT, TMT-A (63.2 ± 29.3 vs. 47.6 ± 16.5 s; p = 0.029) and TMT-B (197.9 ± 88.1 vs. 146.8 ± 76.5 s; p = 0.03). No differences were observed with respect to age, gender, and education. In conclusion, MMSE proved to be a useful tool for detecting global cognitive impairment experienced by cirrhosis patients. Moreover, the most impaired cognitive functions were verbal episodic memory and information processing speed. These findings suggest that minimal hepatic encephalopathy represents a disorder that affects the medial temporal system and, possibly, the prefrontal cortex, and this requires further study.
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Affiliation(s)
- D. S. Torres
- Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ Brazil
- Serviço de Gastroenterologia e Hepatologia do Hospital Universitário Gaffrée e Guinle (Hepatology Outpatient Clinic of the Gaffrée and Guinle University Hospital), Rua Mariz e Barros, 775, Tijuca, Rio de Janeiro, RJ Brazil 20270‐004
| | - J. Abrantes
- Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ Brazil
- Serviço de Gastroenterologia e Hepatologia do Hospital Universitário Gaffrée e Guinle (Hepatology Outpatient Clinic of the Gaffrée and Guinle University Hospital), Rua Mariz e Barros, 775, Tijuca, Rio de Janeiro, RJ Brazil 20270‐004
| | - C. E. Brandão‐Mello
- Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ Brazil
- Serviço de Gastroenterologia e Hepatologia do Hospital Universitário Gaffrée e Guinle (Hepatology Outpatient Clinic of the Gaffrée and Guinle University Hospital), Rua Mariz e Barros, 775, Tijuca, Rio de Janeiro, RJ Brazil 20270‐004
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Neuropsychological functioning in patients with alcohol-related liver disease before and after liver transplantation. Transplantation 2012; 92:1371-7. [PMID: 22075529 DOI: 10.1097/tp.0b013e3182375881] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cognitive dysfunction is common in both end-stage liver disease and chronic alcohol misuse. The impact of orthotopic liver transplantation (OLT) on neuropsychological function is poorly documented. This prospective study examined changes in cognitive function pre- and post-OLT in patients with alcohol-related liver disease (ALD). METHODS Comprehensive neuropsychological assessment was conducted with 92 abstinent patients with ALD scheduled for OLT. Forty-two patients were available for reassessment 12 months post-OLT. RESULTS Posttransplantation, cognitive performance on all measures fell within normal limits. Greatest improvement occurred in visuomotor speed, complex visual attention processes, and the ability to solve visually presented problems. Performance on memory assessment tasks also improved posttransplantation. Applying a more robust assessment of change (Reliable Change Index), approximately half improved reliably on overall cognitive function. One quarter improved in memory performance. With the exception of the Full-Scale Intelligence Quotient scales, discriminant analysis was unable to successfully predict which patients reliably improved. CONCLUSIONS Overall improvement in cognitive function occurs after liver transplantation in ALD. It was not possible to identify which patient characteristics were associated with reliable change.
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