Depressive episode incidence in patients with chronic hepatitis c treated with pegylated interferon and ribavirin

ABSTRACT Background The effectiveness of antiviral therapy with pegylated interferon and ribavirin for chronic hepatitis C is far from ideal and presents several adverse events. Among such events, there is the depressive episode that can even lead to treatment discontinuity Objective Analyze the incidence of depressive episodes in patients with chronic hepatitis C treated with pegylated interferon (IFN-PEG) and ribavirin, as well as the possible factors associated with its occurrence and its impact on patients' sustained virological response. Methods People with chronic hepatitis C undergoing antiviral therapy were interviewed at the baseline, at the 4th, 12th, 24th and 48th treatment weeks and 4 weeks after the end of it, using the HADS scale for tracking the depressive episode. Patients with HADS ≥9 were subjected to Beck Depression Inventory (BDI-II) to grade the episode. Clinical, sociodemographic, laboratorial and histological variables were obtained to identify factors related to the onset of depression. The sustained virological response rate (negative HCV-RNA 6 months after end of therapy) was compared among patients with and without depressive symptoms. Results The study comprised 32 patients, most men (59%) with mean age of 54±11.13 years old. Genotype non-1 was prevalent (56%) and 81% of the patients were non-cirrhotic. The depressive episode was diagnosed in 25% of the patients and the peak incidence was found in the 12th treatment week. The depressive episode was moderate in 87% of the patients and only one patient abandoned the treatment. None of the analyzed factors was associated with depressive episode onset. A trend was observed in female patients ( P=0.08). The sustained virological response rate was of 75% and 67% in patients with and without depressive episode, respectively (P =0.66). Conclusion The incidence of depressive episodes in patients with chronic hepatitis C undergoing antiviral therapy was of 25% and the 12th treatment week was the most critical one. The presence of depressive episode did not affect the sustained virological response rate.

RESUMO Contexto A terapia antiviral para a hepatite C crônica com interferon peguilado e ribavirina tem eficácia longe do ideal e é repleta de eventos adversos. Entre estes, destaca-se o transtorno depressivo que pode inclusive levar a interrupção do tratamento. Objetivos Em pacientes com hepatite C crônica tratados com interferon peguilado (IFN-PEG) e ribavirina, verificar a incidência de episódio depressivo, os possíveis fatores associados ao seu surgimento e o impacto deste sobre a resposta virológica sustentada. Métodos Portadores de hepatite C crônica submetidos à terapia antiviral foram entrevistados no Baseline, nas semanas 4, 12, 24, 48 de tratamento e quatro semanas após o término do mesmo utilizando a escala HADS para rastreamento do episódio depressivo e naqueles com HADS ≥9 o Inventário de Depressão de Beck (BDI-II) para graduação do episódio. Variáveis clínicas, sociodemográficas, laboratoriais e histológicas foram obtidas com o objetivo de identificar os fatores relacionados ao surgimento da depressão. A taxa de resposta virológica sustentada (HCV-RNA negativo seis meses após a interrupção da terapia) foi comparada entre os pacientes com e sem sintomas depressivos. Resultados Foram incluídos 32 pacientes, a maioria do sexo masculino (59%) e com média de idade de 54±11,13 anos. Prevaleceu o genótipo não 1 (56%) e 81% dos pacientes foram não cirróticos. Episódio depressivo foi diagnosticado em 25% dos pacientes sendo o pico de incidência observado na semana 12 de tratamento. O episódio depressivo foi moderado em 87% dos pacientes e motivou a interrupção em somente 1 deles. Nenhum dos fatores analisados foi associado ao surgimento de episódio depressivo observando-se uma tendência com relação ao sexo feminino ( P =0,08). A taxa de resposta virológica sustentada foi 75% e 67% nos pacientes com e sem episódio depressivo, respectivamente ( P =0,66). Conclusão A incidência de episódio depressivo em pacientes com hepatite C crônica submetidos à terapia antiviral foi de 25% e a semana 12 é a mais crítica. A presença de episódio depressivo não interferiu na taxa de resposta virológica sustentada.

Assessment of health-related quality of life and related factors in patients with chronic liver disease

ABSTRACT BACKGROUND AND OBJECTIVES: Assessing health-related quality of life is an important aspect of clinical practice. Thus, the present study attempts to assess the health-related quality of life of patients with chronic liver disease. METHODS: A cross-sectional survey was conducted on 133 chronic liver disease patients, using three instruments: a demographic questionnaire, the Chronic Liver Disease Questionnaire, and Model for End-Stage Liver Disease index. Variables were expressed as frequencies, percentages, means, and standard deviations. The statistical analysis included Pearson's correlation, Student's t-test, and analysis of variance (p < 0.05 was considered significant). RESULTS: The mean age of included subjects was 50.5 ± 13.3 years. The majority were male (66.2%), Caucasian (70.7%), and had a family income of US$329-US$658.2. Over half of the patients (56.4%) were infected by hepatitis C virus and 93.2% had low Model for End-Stage Liver Disease scores. Model for End-Stage Liver Disease score was related to age (r = 0.185;p = 0.033). Higher mean Chronic Liver Disease Questionnaire scores were obtained for emotional function (39.70/SD ± 12.98) and while lower scores were obtained for abdominal symptoms (16.00/SD ± 6.25). Fifty-two patients (39.1%) presented overall low (<5) Chronic Liver Disease Questionnaire scores. Furthermore, Chronic Liver Disease Questionnaire score was related to family income (r = 0.187, p = 0.031). CONCLUSION: Most individuals presented high mean Chronic Liver Disease Questionnaire scores, indicating low health-related quality of life, especially individuals with low family income.

Sexual dysfunction and dissatisfaction in chronic hepatitis C patients

Introduction The prevalence of sexual dysfunction (SD) and dissatisfaction with sexual life (DSL) in patients with chronic hepatitis C virus infection (CHC) was jointly investigated via a thorough psychopathological analysis, which included dimensions such as fatigue, impulsiveness, psychiatric comorbidity, health-related quality of life (HRQL) and sociodemographic and clinical characteristics. Methods Male and female CHC patients from an outpatient referral center were assessed using the Brief Fatigue Inventory, the Barrat Impulsiveness Scale, the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale (HAM-A), and the World Health Organization Quality of Life Scale-Brief Version (WHOQOL-BREF). Structured psychiatric interviews were performed according to the Mini-International Neuropsychiatric Interview. SD was assessed based on specific items in the BDI (item 21) and the HAM-A (item 12). DSL was assessed based on a specific question in the WHOQOL-BREF (item 21). Multivariate analysis was performed according to an ordinal linear regression model in which SD and DSL were considered as outcome variables. Results SD was reported by 60 (57.1%) of the patients according to the results of the BDI and by 54 (51.4%) of the patients according to the results of the HAM-A. SD was associated with older age, female gender, viral genotype 2 or 3, interferon-α use, impulsiveness, depressive symptoms, antidepressant and benzodiazepine use, and lower HRQL. DSL was reported by 34 (32.4%) of the patients and was associated with depressive symptoms, anxiety symptoms, antidepressant use, and lower HRQL. Conclusions The prevalence of SD and DSL in CHC patients was high and was associated with factors, such as depressive symptoms and antidepressant use. Screening and managing these conditions represent significant steps toward improving medical assistance and the HRQL of CHC patients. .

Depressive symptoms and harmful alcohol use in hepatitis C patients: prevalence and correlates

Introduction It is important to understand the characteristics and vulnerabilities of people who have hepatitis C because this disease is currently an important public health problem. The objective of this study was to estimate the prevalence of depressive symptoms and harmful alcohol use in patients with hepatitis C and to study the association between these outcomes and demographic, psychosocial and clinical variables. Methods This cross-sectional, descriptive and analytical study involved 82 hepatitis C patients who were being treated with pegylated interferon and ribavirin at a public university hospital. The primary assessments used in the study were the Alcohol Use Disorders Identification Test and the Beck Depression Inventory. Bivariate analyses were followed by logistic regression. Results The prevalence of depressive symptoms was 30.5% (n=25), and that of harmful alcohol use was 34.2% (n=28). Logistic regression analysis showed that individuals who were dissatisfied with their social support (OR=4.41; CI=1.00-19.33) and were unemployed (OR=6.31; CI=1.44-27.70) were at a higher risk for depressive symptoms, whereas harmful alcohol use was associated with the male sex (OR=6.78; CI=1.38-33.19) and the use of illicit substances (OR=7.42; CI=1.12-49.00). Conclusions High prevalence rates of depressive symptoms and harmful alcohol use were verified, indicating vulnerabilities that must be properly monitored and treated to reduce emotional suffering in this population. .

Health related quality of life among patients with chronic hepatitis C: a cross-sectional study of sociodemographic, psychopathological and psychiatric determinants

INTRODUCTION: Chronic hepatitis C virus infection patients have higher rates of psychiatric disorders than the general population. Chronic hepatitis C virus infection is known to be associated with impaired health related quality of life. To our knowledge, there is no previous research of health related quality of life in chronic hepatitis C patients that combined structured psychiatric interview and careful psychopathological evaluation, including depression, anxiety and fatigue instruments. The aim of this study was to evaluate health related quality of life of chronic hepatitis C patients and to investigate the association with sociodemographic, psychopathological and psychiatric factors. MATERIALS AND METHODS: Eighty-one individuals with chronic hepatitis C virus infection receiving care at a Brazilian public university-based outpatient service for infectious diseases were enrolled in the study. The World Health Organization Quality of Life Scale Brief Version was used to assess health related quality of life. Standard psychiatric interview (Mini International Neuropsychiatric Interview-Plus) was conducted to establish Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I psychiatric diagnosis. Further instruments completed psychopathological investigation: Beck Depression Inventory, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, Hamilton Depression Scale and Hamilton Anxiety Scale. Pearson Chi-Square and Kruskal-Wallis were performed for categorical and continuous univariate analysis, respectively. Correlation between psychopathological and health related quality of life scores was performed according to Spearman's correlation. Multivariate analysis was performed according to stepwise forward ordinal logistic regression. The significance threshold was fixed at α = 0.05. RESULTS: Depressive disorders were associated with worse scores in overall health related quality of life and in all domains. Fatigue was associated with lower scores in physical and psychological domains, and married status with higher scores in psychological health related quality of life. We found strong correlation among scores of depression, fatigue and health related quality of life. CONCLUSION: Depression and fatigue must be properly investigated and managed in HCV patients in order to improve HRQL. WHOQOL-BREF proved to be a useful instrument to assess HRQL in HCV patients.

Quality of life of patients with hepatitis C / Qualidade de vida de pacientes com hepatite C

INTRODUCTION: Self-report on the quality of life (QOL) is increasingly studied in the evaluation of various diseases, especially in chronic ones. However, there are few data in the literature focusing the QOL of patients living with chronic hepatitis C. The objective of this study was to evaluate the QOL in patients with hepatitis C assessed by the World Health Organization Quality of Life Assessment (WHOQOL)-bref scale. METHODS: One hundred and eight hepatitis C patients attending the Outpatient Healthcare Medical Specialties in Tubarão, State of Santa Catarina, Brazil, were contacted from May 2010 to February 2011. Patients answered the WHOQOL-bref scale and a questionnaire about their treatment and risk factors to hepatitis C virus (VHC) infection. RESULTS: Although most of patients with chronic hepatitis C considered their QoL good or very good (58.1%), 47 (44.8%) patients were poorly or very poorly satisfied with their health. About the WHOQOL answers, the environment domain had the highest score (25.15 + 5.77), while the lowest score was the social relationships domain (9.19 + 2.5). There was statistically significant association between household income and quality of life in all domains (p<0.001) and statistically significant association between education and the physical, psychological and social domains of quality of life (p<0.05). CONCLUSIONS: Based on the answers given in WHOQOL-bref, patients with chronic hepatitis C have a generally poor QOL, especially in social relationship domain. Household income and educational level were factors that interfered significantly with patients' QOL assessment.

INTRODUÇÃO: O autorrelato sobre a qualidade de vida (QV) é cada vez mais estudado na avaliação de várias doenças, especialmente nas crônicas. No entanto, existem poucos dados na literatura focando a QV de pacientes vivendo com hepatite C crônica. O objetivo deste estudo foi avaliar a QV em pacientes com hepatite C através da escala World Health Organization Quality of Life Assessment versão breve (WHOQOL-bref). MÉTODOS: Foi feito contato com 108 pacientes de hepatite C que frequentavam o Ambulatório Médico de Especialidades em Tubarão, Santa Catarina, Brasil, de maio de 2010 a fevereiro de 2011. Os pacientes responderam ao WHOQOLbref e a um questionário sobre o seu tratamento e fatores de risco à infecção pelo vírus da hepatite C (VHC). RESULTADOS: Embora a maioria dos pacientes com hepatite C crônica considerasse sua QV boa ou muito boa (58,1%), 47 (44,8%) dos pacientes estavam nada ou muito pouco satisfeitos com a sua saúde. Sobre as respostas do WHOQOL, o domínio ambiental obteve o escore mais alto (25,15 + 5,77), enquanto o menor escore foi do domínio relações sociais (9,19 + 2,5). Houve associação estatística significativa entre renda familiar e qualidade de vida em todos os domínios (p<0,001) e associação estatística significativa entre educação e os domínios físico, psicológico e social da qualidade de vida (p<0,05). CONCLUSÕES: Baseado nas respostas dadas no WHOQOL-bref, pacientes com hepatite C crônica têm uma QV geralmente pobre, especialmente no domínio relações sociais. A renda familiar e o nível de educação foram fatores que interferiram significativamente na auto-avaliação da qualidade de vida dos pacientes.

Validade e precisão do Questionário de Relacionamento Central 6.0 (CRQ 6.0) para adultos com hepatite C crônica / Validity and reliability of the Central Relationship Questionnaire 6.0 (CRQ 6.0) for adults suffering from Chronic Hepatitis C / Validez y fiabilidad de lo Cuestionario de Relación Central 6.0 (CRQ 6.0) para adultos con Hepatitis C Crónica

Portadores de hepatite C têm grande probabilidade de apresentar sintomas psicopatológicos e conflitos no relacionamento amoroso. Objetivou-se medir a precisão (consistência interna) e a validade (convergente e discriminante) do Questionário de Relacionamento Central 6.0 - CRQ 6.0, para adultos com hepatite C crônica. O CRQ 6.0, de autorrelato, avalia o padrão de relacionamento do indivíduo, segundo três componentes: Desejos (D), Respostas do Outro (RO), Respostas do Eu (RE). Participaram do estudo pacientes ambulatoriais com hepatite C crônica (G1, n = 61) e acompanhantes de pacientes (G2, n= 40). Todos responderam ao CRQ 6.0 e à Escala de Avaliação de Sintomas-40 (EAS-40). Os resultados indicaram consistência interna aceitável para os componentes do CRQ 6.0. Eles se correlacionaram significantemente com sintomas psicopatológicos pela EAS-40. Os escores do CRQ 6.0 foram significantemente mais elevados para participantes de G1, quando comparados aos de G2 (RO e RE), participantes sob medicação (RE) e mulheres (D e RE).

People suffering from chronic hepatitis C have great probability of presenting psychopathologic symptoms and difficulties on relationships with romantic partners. This study aimed to estimate the internal consistency, convergent validity and discriminant validity of the Central Relationship Questionnaire 6.0 (CRQ 6.0) for adults with chronic hepatitis C. The CRQ 6.0 is a self-report, developed to assesses the individuals relationship patterns according to three components: Wishes (W), Responses from Others (RO), Responses of Self (RS). Participants were patients with chronic hepatitis C (G1, n = 61) and persons who accompanied patients (G2, n = 40). They answered to the CRQ 6.0 and to the Symptoms Assessment Scale-40 (EAS-40). Results pointed to the acceptable internal consistency of the CRQ 6.0s components. They significantly correlated to psychopathological symptoms with EAS-40. Scores of the CRQ 6.0 were significantly higher for: participants of G1 (RO, RS), participants under medication (RS) and women (W, RS).

Personas con hepatitis C crónica presentan alta probabilidad de sufrir de síntomas psicopatológicos y conflictos en las relaciones amorosas. El estudio tuvo como objetivo obtener pruebas de fiabilidad (consistencia interna), validad convergente y validad discriminante de lo Cuestionario de Relación Central 6.0 (CRQ 6,0) para adultos con hepatitis C crónica. El CRQ 6.0, de auto-informe, evalúa el patrón de relación del individuo en tres dimensiones: Deseos (D) Respuestas del Otro (RO), Respuestas del Self (RS). Participaran pacientes con hepatitis crónica C (G1, n = 61) y acompañantes de pacientes (G2, n = 40). Todos han respondido al CRQ 6.0 y Escala de Evaluación de Síntomas-40 (EAS-40). El CRQ 6.0 mostró consistencia interna aceptable en sus componentes y correlaciones significantes con síntomas psicopatológicos pela EAS-40. Los escores de CRQ60 fueran significantemente más altos para: participantes de G1 (RO, RS), participantes que tomaban medicación (RS), y para mujeres (D y RS).

Clinical management of a patient with drug dependence who attempted suicide while receiving peginterferon therapy for chronic hepatitis C

Pegylated interferon-alpha combined with ribavirin is the current gold standard treatment for chronic hepatitis C. Illicit drug dependence is not a rare co-morbidity among chronic hepatitis C population, what can make antiviral treatment an outmost challenge. Despite high sustained virological response rate following antiviral treatment, serious psychiatric adverse reactions may occur, like depression and suicide attempt. We report a patient with recurrent depressive disorder, previous history of suicide attempt and illicit drug dependence. We discuss the singularities and challenges of managing this patient in order to complete the antiviral treatment.

Impact of psychiatric disorders on the quality of life of brazilian HCV-infected patients

The aim of our study was to determine the impact of psychiatric comorbidities on the health-related quality of life of HCV-infected patients. Assessment of clinical, socio-demographic and quality of life data of the patients followed up at a Hepatology unit was performed by using a standard questionnaire and the SF-36 instrument. Psychiatric diagnoses were confirmed by using the Mini International Neuropsychiatric Interview, Brazilian version 5.0.0 (MINI Plus). Evaluation using the MINI plus demonstrated that 46 (51 percent) patients did not have any psychiatric diagnosis, while 44 (49 percent) had at least one psychiatric diagnosis. Among patients with a psychiatric comorbidity, 26 (59.1 percent) had a current mental disorder, out of which 22 (84.6 percent) had not been previously diagnosed. Patients with psychiatric disorders had lower scores in all dimensions of the SF-36 when compared to those who had no psychiatric diagnosis. Scores of physical functioning and bodily pain domains were lower for those suffering from a current psychiatric disorder when compared to those who had had a psychiatric disorder in the past. Females had lower scores of bodily pain and mental health dimensions when compared to males. Scores for mental health dimension were also lower for patients with advanced fibrosis. The presence of a psychiatric comorbidity was the variable that was most associated with the different scores in the SF-36, compared to other variables such as age, gender, aminotransferase levels, and degree of fibrosis.

Patient concerns regarding chronic hepatitis B and C infection

Counselling of patients with viral hepatitis is often limited to discussions about how the virus is transmitted. The aim of the present study was to document the principal concerns of patients suffering from chronic hepatitis B and C infection. The most common volunteered concerns were infecting family members [80.6%], infecting others [66.7%], side-effects of treatment [50.0%], disease progression to cirrhosis [44.4%], loss of employment [41.7%], liver transplantation [36.1%], social stigma [36.1%], change in lifestyle [33.3%], development of liver cancer [25%], costs and money [22.2%], fear of disease [5.6%] and psychological disease [5.6%]. Health care providers who focus counseling efforts exclusively on viral transmission are unlikely to address other important concerns