Anxiety and depression symptoms in hepatic encephalopathy: are they psychiatric or organic?

BACKGROUND: Hepatic encephalopathy (HE) represents a broad continuum of neuropsychiatric abnormalities, from subtly altered mental status to deep coma, seen in patients with liver dysfunction. HE can mimic all of the major psychiatric syndromes. The distinction between HE and a psychiatric condition, namely depression, is sometimes difficult. Some liver patients end up being medicated with psychiatric drugs which might worsen their medical state. The main objective of this study was to try to find the correlations between anxiety and depression symptoms and the presence of HE to better diagnose and treat these patients. METHODS: Sixty consecutive liver transplant candidates, attending the outpatient clinics of a liver transplantation center were studied from January 1, 2012, to December 1, 2012. Each patient was assessed by means of Psychometric Hepatic Encephalopathy Score subtests and Hospital Anxiety and Depression Scale. RESULTS: We found a statistically significant relationship between HE and some of the depressive symptoms: anhedonia and loss of energy. CONCLUSIONS: These findings may indicate that when in the presence of an HE patient with depressive symptoms, HE-directed therapies should be attempted before antidepressant drugs.

Psychiatric and psychosocial predictors of medical outcome after liver transplantation: a prospective, single-center study.

OBJECTIVE: Recognizing the potential impact of psychiatric and psychosocial factors on liver transplant patient outcomes is essential to apply special follow-up for more vulnerable patients. The aim of this article was to investigate the psychiatric and psychosocial factors predicted medical outcomes of liver transplanted patients. METHODS: We studied 150 consecutive transplant candidates, attending our outpatient transplantation clinic, including 84 who had been grafted 11 of whom died and 3 retransplanted. RESULTS: We observed that active coping was an important predictor of length of stay after liver transplantation. Neuroticism and social support were important predictors of mortality after liver transplantation. CONCLUSION: It may be useful to identify patients with low scores for active coping and for social support and high scores for neuroticism to design special modes of follow-up to improve their medical outcomes.

Mental health and quality of life in alcoholic liver disease patients after liver transplantation: a prospective controlled study.

OBJECTIVE: Alcoholic liver disease (ALD) is one of the most important indications for liver transplantation. Discordant conclusions have been found concerning quality of life and mental health after transplantation in this particular group. The aim of this work was to investigate improvements in mental health and quality of life among transplanted patients for ALD. METHODS: We studied 45 consecutive transplant candidates with ALD, attending the outpatient clinics. Among these patients we transplanted 24 with the control candidates remaining in wait for transplantation. RESULTS: There was a significant improvement in all mental health and quality of life dimensions among the transplanted ALD group. We also observed a favorable evolution of coping mechanisms (CM) in this group. CONCLUSION: There is a favorable adjustment of ALD patients after transplantation as shown in CM evolution, which might explain the improved mental health and quality-of-life dimensions.

Adherence correlates in liver transplant candidates.

The study sought to investigate the psychiatric and psychosocial correlates of multidimensional adherence among liver transplant candidates. A liver transplant candidate sample (N = 100), comprising consecutive patients attending outpatient clinics of a liver transplantation central unit, was assessed by means of the Multidimensional Adherence Questionnaire (MAQ; Telles-Correia 2007), the Diagnostic and Statistical Manual of Mental Disorders, Revised 4th Edition (DSM-IV-TR) criteria, the Toronto Alexithymia Scale (TAS), the NEO Five-Factor Inventory (NEO-FFI) personality inventory, the Hospital Anxiety and Depression Scale (HADS), the Brief COPE, and the Psychological Assessment of Candidates for Transplantation (PACT). We found that multidimensional adherence positively correlated with personality traits (agreeableness), good social support, and coping strategies (planning).

Importance of depression and active coping in liver transplant candidates' quality of life.

OBJECTIVE: To investigate the importance of psychiatric and psychological factors such as depression, anxiety, personality traits, and coping strategies in liver transplant candidates' quality of life. METHODS: A total of 131 consecutive liver transplant candidates attending outpatient clinics at a liver transplantation central unit were assessed by means of the Medical Outcomes Study Short Form quality-of-life questionnaire, psychiatric diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, a personality inventory (NEO Five-Factor Inventory), the Hospital Anxiety and Depression Scale, and the Brief COPE scale. RESULTS AND CONCLUSIONS: Both physical and mental components of quality of life are far more correlated with depression and active coping strategy than with clinical and sociodemographic factors. Neuroticism was also strongly correlated with the mental component of quality of life, and employment was correlated with the physical component of quality of life.

Psychosocial determinants of quality of life 6 months after transplantation: longitudinal prospective study.

OBJECTIVES: We sought to investigate the psychosocial determinants of quality of life at 6 months after transplantation. METHODS: A sample of liver transplant candidates (n = 60), composed of consecutive patients (25% with familial amyloid polyneuropathy [FAP]) attending outpatient clinics was assessed in the pretransplant period using the Neo Five Factor Inventory, Hospital Anxiety and depression Scale (HADS), Brief COPE, and SF-36, a quality-of-life, self-rating questionnaire. Six months after transplantation, these patients were assessed by means of the SF-36. RESULTS: Psychosocial predictors where found by means of multiple regression analysis. The physical component of quality of life at 6 months after transplantation was determined based upon coping strategies and physical quality of life in the pretransplant period (this model explained 32% of variance). The mental component at 6 months after transplantation was determined by depression in the pretransplant period and by clinical diagnoses of patients. Because FAP patients show a lower mental component of quality of life, this diagnosis explained 25% of the variance. CONCLUSIONS: Our findings suggested that coping strategies and depression measured in the pretransplant period are important determinants of quality of life at 6 months after liver transplantation.

When does quality of life improve after liver transplantation? A longitudinal prospective study.

OBJECTIVES: We sought to investigate the improvement in quality of life (mental and physical components) at 1 and 6 months after liver transplantation. METHODS: A sample of liver transplant candidates (n = 60), comprising consecutive patients attending outpatient clinics of a liver transplantation central unit (25% of the patients had familial amyloid polyneuropathy [FAP] and the remaining patents had chronic liver diseases), was assessed by means of the Short Form (SF)-36, Portuguese-validated version, a self-rating questionnaire developed by the Medical Outcome Trust, to investigate certain primary aspects of quality of life, at 3 times: before, and at 1 and 6 months after transplantation. RESULTS: We observed a significant improvement in quality of life (both mental and physical components) by 1 month after transplantation. Between the first month and the sixth month after transplantation, there also was an improvement in the quality of life (both mental and physical components), although only the physical components of quality of life was significantly improved. CONCLUSIONS: Our findings suggested that quality of life improved early after liver transplantation (1 month). Between the first and the sixth months, there only was a significant improvement in the physical quality of life.