Coping Through Religiosity, Spirituality and Social Support Among Muslim Chronic Hepatitis Patients.

Academics acknowledge religiosity, spirituality and social support as socio-behavioral factors that influence patients' ability to deal with chronic illness. This study has attempted to describe empirical reality of how these factors influence patients. The sample of this study was 500 chronically ill hepatitis patients and was selected through the multistage sampling techniques. Through structured interview schedule, data were collected during the period of September 2016 to March 2017 from five most populated cities of Punjab (Pakistan). Data were analyzed through descriptive (frequency and percentage) and inferential statistics (Cronbach's alpha, Pearson correlation, and structural equation modeling). The study suggests some recommendations and suggestions to policy makers regarding the significance of religiosity, spirituality and social support as coping strategies during chronic illness. The findings illustrate that social support has more association with coping than religiosity and spirituality of the patients.

Hepatitis-related stigma in chronic patients: A qualitative study.

BACKGROUND: Hepatitis is one of health problems throughout the world. It has numerous consequences on patients' life. Stigma, depression, social marginalization and financial problems are some of the challenges in these patients. AIM: The purpose of this qualitative study was to examine hepatitis-related stigma and discrimination in patients living with chronic hepatitis in Iranian society. METHODS: This present study was designed as a qualitative method, and this article shows up the results of a qualitative research study undertaken with patients living with hepatitis in Iran. The study uses a content analysis method. A purposive sample of 18 patients was chosen. Data were collected through a semi-structured interview and field note that the researchers will take during participants' observation. Data analysis process was performed on the texts which were generated from verbatim transcripts of the participants interviews. RESULTS: Participants were between 18 and 61 years old. The main theme, Stigma, emerged from three themes during the process data analysis in this study. These themes were including fear to lose of family and social support, fear to present in public and fear of transmission. CONCLUSIONS: This research indicates that stigma presents major challenges not only for patients living with chronic hepatitis but also for nurses, other healthcare practitioners, family and social networks, institutions and society. The researcher suggests that interventions to reduce or eliminate stigma should require individual, structural, cultural thought, society and systemic changes.

Assessment of depression and anxiety in patients with chronic liver disease.

BACKGROUND/AIM: In recent years mental health of patients including those with chronic liver disease (CLD), has become interesting because its disturbance leads to reduced quality of life, that is associated with worsening of clinical outcome, reduced compliance and increased mortality. The aim of the study was to determinate the frequency and severity of depression and frequency of anxiety in patients with CLD and to assess the contribution of selected socio-demographic, clinical and laboratory risk factors for depression and anxiety. METHODS: In this cross-sectional study, we used the Hamilton depression rating scale (HDRS) and Hamilton anxiety rating scale (HARS) in patients with CLD. RESULTS: The study included 54 male and 43 female patients. Depression was present in 62.9%, and anxiety in 13.4% of the patients. A higher HDRS was noted in the patients older than 50 years (p = 0.022) and unemployed patients (p = 0.043). The patients with at least one episode of gastrointestinal bleeding had a significantly higher frequency of anxiety than those without bleeding (p = 0.018). A higher HARS score was present in the women (p = 0.011), unemployed patients (p = 0.008) and those with non-alcoholic liver disease (p = 0.007). There was a significant correlation between the mean corpuscular volume (MCV) and the value of the HDRS score, and between serum potassium and sodium levels and HDRS score. CONCLUSION: Age and the mean corpuscular volume have significant influence on the HDRS score while unemployment, gastrointestinal bleeding, serum potassium and serum sodium have predictive value for HARS score.

Validation of the chronic liver disease questionnaire in Serbian patients.

AIM: To translate into Serbian and to investigate the validity of the cross-culturally adapted the chronic liver disease questionnaire (CLDQ). METHODS: The questionnaire was validated in 103 consecutive CLD patients treated between October 2009 and October 2010 at the Clinic for Gastroenterology, Clinical Centre of Serbia, Belgrade (Serbia). Exclusion criteria were: age < 18 years, psychiatric disorders, acute complications of CLD (acute liver failure, variceal bleeding, and spontaneous bacterial peritonitis), hepatic encephalopathy (grade > 2) and liver transplantation. Evaluation of the CLDQ was done based on the following parameters: (1) acceptance is shown by the proportion of missing items; (2) internal reliabilities were assessed for multiple item scales by using Cronbach alpha coefficient; and (3) in order to assess whether the allocation of items in the domain corresponds to their distribution in the original questionnaire (construction validity), an exploratory factor analysis was conducted. Discriminatory validity was determined by comparing the corresponding CLDQ score/sub-score in patients with different severity of the diseases. RESULTS: The Serbian version of CLDQ questionnaire completed 98% patients. Proportion of missing items was 0.06%. The total time needed to fill the questionnaire was ranged from 8 to 15 min. Assistance in completing the questionnaire required 4.8% patients, while 2.9% needed help in reading, and 1.9% involved writing assistance. The mean age of the selected patients was 53.8 ± 12.9 years and 54.4% were men. Average CLDQ score was 4.62 ± 1.11. Cronbach's alpha for the whole scale was 0.93. Reliability for all domains was above 0.70, except for the domain "Activity" (0.49). The exploratory factor analysis model revealed 6 factors with eigenvalue of greater than 1, explaining 69.7% of cumulative variance. The majority of the items (66%) in the Serbian version of the CLDQ presented the highest loading weight in the domain assigned by the CLDQ developers: "Fatigue" (5/5), "Emotional function" (6/8), "Worry" (5/5), "Abdominal symptoms" (0/3), "Activity" (0/3), "Systemic symptoms" (3/5). The scales "Fatigue" and "Worry" fully corresponded to the original. The factor analysis also revealed that the factors "Activity" and "Abdominal symptoms" could not be replicated, and two new domains "Sleep" and "Nutrition" were established. Analysis of the CLDQ score/sub-score distribution according to disease severity demonstrated that patients without cirrhosis had lower total CLDQ score (4.86 ± 1.05) than those with cirrhosis Child's C (4.31 ± 0.97). Statistically significant difference was detected for the domains "Abdominal symptoms" [F (3) = 5.818, P = 0.001] and "Fatigue" [F (3) = 3.39, P = 0.021]. Post hoc analysis revealed that patients with liver cirrhosis Child's C had significantly lower sub-score "Abdominal symptoms" than patients without cirrhosis or liver cirrhosis Child's A or B. For domain "Fatigue", patients with cirrhosis Child's C had significantly lower score, than non-cirrhotic patients. CONCLUSION: The Serbian version of CLDQ is well accepted and represents a valid and reliable instrument in Serbian sample of CLD patients.

[Anxiety level studies in patients with chronic liver diseases].

The results of complex neurological and neuropsychological study with evaluation of anxiety levels in young and middle-age patients with chronic hepatitis and liver cirrhosis are presented in the article. Raised anxiety levels with statistically significant difference to control group patients were found. By turn, anxiety levels in patients with chronic hepatitis were lower than in patients with liver cirrhosis. The most of examined patients had middle (with tendency to low level as well as with tendency to high level) and high level of anxiety.

[Somatopsychic manifestations in patients with chronic viral hepatitis].

The aim of the work was to study somatopsychic manifestations in patients with chronic viral hepatitis (CVH). MMPI profiles, state and trait anxiety were assessed in 110 patients. Boundary psychic problems were evaluated using the Beck scale. It was shown that mean MMPI T-score in patients with CVH was above 50; half of them developed "neurotic triad"; hypochondria occurred in 37.3%, depression in 42.7%, and hysteria in 37.1%. The highest level of state anxiety was documented in patients with HCV infection and isolated HBCor At. The CVH-1b genotype was associated with enhanced occurrence of depression in patients having virus-positive blood for 1-5 years. The level of state and trait anxiety in them was lower than in patients with duration of viremia over 5 years.

Impairment of driving ability and neuropsychological function in patients with MHE disease.

Minimal hepatitis encephalopathy (MHE) is a liver cirrhosis complication that does not show symptoms of overt hepatitis encephalopathy (OHE) but can be detected using specific complementary neuropsychological and neurophysiological evaluations. Patients with MHE show abnormalities in cognitive functions, which can increase the risk of automobile accidents. The aim of this study was to compare the cognitive functioning of patients with MHE to patients with other liver disease and to compare their driving abilities, using a driving simulator and the Stim(2) software. Thirty-eight participants, who were not diagnosed with OHE but were diagnosed with chronic hepatitis and liver cirrhosis, took part in the study. The results indicate that patients with MHE show reduced level of cognitive functioning, which may affect their ability to drive safely. We cautiously predict that any future guidelines based on this knowledge may help reduce the incidence of traffic accidents caused by drivers with decreased with driving abilities.

[Evaluation of quality of life in children with chronic hepatitis]. / Studiu de evaluare a calitatii vietii la copilul cu hepatita cronica.

UNLABELLED: The evolution of chronic viral and non-viral hepatitis in children, and the response to therapy influence the quality of life and the outcome of these patients and tehir family. MATERIAL AND METHOD: This study analyzes the quality of life in children with chronic liver disease, using the records of 45 patients hospitalised in the Hepatology Department of "Sf. Maria" Hospital of Children in Iasi. Data were customised using Kindle questionnaire, measuring the scores for quality of life in children and adolescents with chronic disease. Patients with chronic viral and autoimmune hepatitis hospitalised in the clinic were interrogated during three months (May-July 2008). All ethical aspects of clinical research were aproved and no child was harmed during the study. The questionnaire for children with chronic viral hepatitis, mostly with B virus, had a good aplicability, being simple and easy to respond. RESULTS: The results showed a positive perception of the disease, probably because of the young age (under 17) and the fact that the liver disfunction was at low rates. The study of quality of life in children with chronic disease can be an efficient method for treatment efficiency evaluation.

[Study on depression in 212 patients with viral hepatitis].

OBJECTIVE: To investigate the symptoms on depression in patients with viral hepatitis. METHODS: A cross-sectional study was conducted among the patients with viral hepatitis in infectious diseases Hospital of Taiyuan. The questionnaire included a Eysenck Personality Questionnaire, self-rating depression scale (SDS), and a self-designed one related to information regarding general conditions of the disease and social support. RESULTS: (1) Depression symptom prevalence rate among chronic viral hepatitis patients was 54.7% (116/212). (2) Factors as age, occupation, education, confirmed time, number of recurrence and anti-virus treatment, self-confidence on recovery, satisfaction on the surrounding environment etc. that might be associated with depression. (3) The severity of depression was significantly negative correlation with social support scores, objective support scores, subjective support scores (r = -0.262, P = 0.000; r = -0.228, P = 0.001; r = -0.270, P = 0.000). (4) There was positive correlation noticed between severity of the depressive disorder and Eysenck Personality two dimensions scores, while the scores of introversion and extroversion scores were negatively correlated (r = -0.330, P = 0.000) but positively correlated to the emotional stability scores (r = 0.309, P = 0.000). CONCLUSION: (1) Patients with hepatitis showed symptoms of depression to a certain degree. (2) Factors as age, occupation, education, economic situation, confirmed time of diagnosis, number of recurrence and anti-virus treatments, confidence on recovery, satisfaction on the surrounding environment might be associated with symptoms of depression. (3) There was positive correlation between severity of depressive and Eysenck Personality two dimensions scores but the scores of introversion and extroversion scores were negatively correlated.

Prevalence of moderate and severe depression among Croatian patients infected with human immunodeficiency virus.

The aim of the study was to assess the prevalence of depression among Croatian patients infected with human immunodeficiency virus (HIV) and to make a comparison with patients with other acute and chronic infectious diseases. We assessed the depressive disorder using the Beck Depression Inventory questionnaire (BDI), without clinical confirmation. The BDI scores were examined in 80 HIV-infected persons and compared to 80 persons with chronic viral hepatitis and 78 with acute infectious diarrhea. All examinees were treated as outpatients at the University Hospital for Infectious Diseases in Zagreb in March and April of 2003. Prevalence of moderate and severe depression among HIV-infected was 16/80 (20%) with a 95% confidence interval 11% to 29%. Male patients with HIV or chronic viral hepatitis had a significantly higher BDI scores than males with acute infectious diarrhea (p = 0.017, Kruskall-Wallis, d.f. 2). Female patients with HIV infection tended to have a lower BDI score than females with chronic viral hepatitis or acute infectious diarrhea (p = 0.087, Kruskall-Wallis, d.f. 2). Prevalence of moderate and severe depression among Croatian HIV-positive patients is higher than the upper estimate for general population. Croatian males with chronic infectious disease have higher rate of depression than those with acute infectious disease.

The monoethylglycinexylidide test does not impair psychometric performance in patients with chronic hepatitis or cirrhosis.

Lidocaine (LID) is an aminoethylamide used in hepatology to perform the monoethylglycinexylidide (MEGX) test for the evaluation of liver function in patients with cirrhosis (CIR) or chronic hepatitis (CH). The authors evaluated whether the MEGX test changes psychometric performance in patients with chronic liver disease and, in particular, whether it might trigger subclinical portosystemic encephalopathy in patients with CIR. Thirty patients with CIR and 20 patients with CH were studied. They underwent a standard-dose MEGX test, before and after which a psychometric test was administered and blood pressure, heart rate, and adverse effects were recorded. The MEGX test did not modify psychometric performance. Mean arterial blood pressure and heart rate did not change at the end of the MEGX test in either patients with CH or CIR. Adverse effects were present in 66% of all patients during lidocaine injection and lasted up to 3 minutes afterwards. They were more frequent in patients with CH than in patients with CIR (85% vs 53%). No relationship was found between adverse effects and lidocaine dosage, nor between adverse effects and MEGX or lidocaine concentration at 15 minutes. Standard-dose MEGX test does not worsen or trigger portosystemic encephalopathy in CIR. Adverse effects were frequent but mild.

Depression during interferon therapy for chronic viral hepatitis: early identification of patients at risk by means of a computerized test.

OBJECTIVES: At the doses used for the treatment of chronic viral hepatitis, interferon (IFN)-related side-effects are usually modest, even though in some cases they require the interruption of therapy. Neuropsychiatric disturbances that range from modest depression and irritability to forms of manic-depressive psychosis and attempted or successful suicides are among the most important side-effects. The aim of our study was to determine whether the Minnesota Multiphasic Personality Inventory (MMPI) is a sensitive and reliable test for the early identification of patients at risk of depression before IFN therapy is commenced, and whether it could be useful for the monitoring of these patients during treatment. METHODS: We prospectively studied 67 patients with chronic active liver diseases, consecutively enrolled in open studies and treated with r-IFNalpha2. Before starting therapy and after 3 months of treatment, all patients underwent a clinical neurological evaluation and MMPI. RESULTS: At baseline, the correlation between the clinical evaluation and the score of the depression scale of the MMPI was statistically significant (P< 0.0001). Nine of 14 (64.3%) patients with a baseline score > or = 60/100 showed a depressive mood after 3 months of therapy. Five of 44 patients (11.3%) with a baseline score < 60/100 showed a depression of medium level after 3 months of treatment. This difference was highly significant (P< 0.0001). CONCLUSIONS: According to our results, the MMPI is a reliable and sensitive test for the early identification of patients at risk of depression before and during IFN therapy for chronic viral liver diseases.

Psychological distress in patients with chronic, nonalcoholic, uncomplicated liver disease.

To study whether the presence of significant disease in a major organ, possibly with minimal or no clinical symptoms, would be associated with psychological disturbance, 80 subjects suffering from chronic hepatitis or cirrhosis, of nonalcoholic etiology were interviewed. Of these, 64 had either minimal or no physical symptoms. Patients completed the Brief Symptom Inventory (BSI) and the Impact of Event Scale (IES), questionnaires, which measure symptoms of psychological distress. It was found that 50% of the liver subjects were defined as cases by the BSI criteria including 15% who were defined as severe cases. There were no gender differences. Forty-five percent of asymptomatic liver subjects were defined as cases. Psychological distress was significantly pronounced in subjects with less than 12 years of education. This study points to a significant incidence of psychological distress, even in clinically asymptomatic subjects, suffering from chronic, nonalcoholic, uncomplicated liver disease.

[Mental disorders in patients with chronic hepatitis]. / Psikhicheskie narusheniia u bol'nykh khronicheskimi hepatitami]

51 patients with chronic hepatitis were examined clinicopsychopathologically for depression, anxiety, self-estimation, cognitive defects. Non-psychotic mental disorders were found in all the examinees: 15 had asthenia, 36 had asthenia and affective disturbances (astheno-depressive, anxious-depressive, anxious-hypochondriac, hystero-depressive). A correlation exists between psychic disorders, severity of chronic hepatitis, premorbid personality traits and efficacy of therapy. Psychiatrist's observation is needed for early detection and treatment of the above disorders.

A patient with chronic hepatitis C and a history of abuse of analeptic drugs, who showed hallucination and delusion with interferon administration.

We experienced a case of chronic hepatitis type C accompanied with hallucination and delusion induced by interferon (IFN) therapy positive. The case was a 47-year-old male, whose laboratory data showed positive for anti-Hepatitis C Virus (HCV) and elevated transaminase level. He was treated with 6 MU/day of natural-type IFN-alpha (HLBI). Sleeplessness and delusions of persecution developed about 2 months after the start of IFN therapy. The interview of the psychiatrist disclosed that the patient had a history of addiction to drugs, and these psychiatric symptoms were diagnosed as being of "the flashback phenomenon." These side effects were improved after the administration of psychotropics and it was suggested that we had to take care of the development of flashback phenomenon during the treatment of IFN in cases of chronic hepatitis with a history of addiction to drugs.

Non-psychogenic primary polydipsia in autoimmune chronic active hepatitis with severe hyperglobulinaemia.

The association of hyperglobulinaemia with renal tubular acidosis and nephrogenic diabetes insipidus is well established. A patient with marked hyperglobulinaemia due to autoimmune chronic active hepatitis is described who presented with severe polydipsia and polyuria but had entirely normal renal tubular function indicating a primary thirst disorder.

[Comparative studies of the personality structure of the diabetic patient and the patient with chronic liver disease]. / Vergleichende Untersuchungen über die Persönlichkeitsstruktur des Diabetikers und des chronisch Leberkranken.

Not only does the psychological pressure of suffering from a chronic and in most cases incurable disease have a major impact on the patient's mind; it has also to be assumed that it is rather the mental predisposition which contributes to the manifestation of an organic disease and its becoming chronic. Studies of insulin-depending diabetics have shown that with two thirds of the patients there had been a mental conflict which they were unable to cope with prior to the manifestation proper of this metabolic disorder. With type-II diabetics it is an unsurmounted feeling of anxiety and guilt which makes patients break off their interhuman relations and leads, in most cases, to obesity and, eventually, to the manifestation of the disease. Adolescent diabetics who accept the disease as part of their lives once they have overcome their initial feelings of inferiority and recovered a certain mental equilibrium, develop an optimistic and predominantly life-affirming character and tend to restore the self-confidence they had lost. The situation is different with type-II diabetics who, even if the disease has been completely integrated into their lives, will show a basically depressive mood with a distinct lack of open-mindedness and self-criticism. Patients who suffer from a chronic hepatic disease can be characterised by a pronounced hypochondriac and anxious mood which is apparent even before the outbreak of an acute hepatocellular disorder or, at least, before this disease becomes chronic. From the psychological point of view, these persons reveal a marked depressive personality with a neurotic element in it which shows in the course of the disease and even after it has been cured or stopped. As a result, these patients often retire prematurely from their jobs. On the other hand, diabetics will not give up their professional activities unless they are forced to do so because of organic complications or delayed diabetic effects.