in Hepatitis C Patients and Interferon Treatm丙型肝炎患者干扰素治疗抑郁症课件.pptVIP

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in Hepatitis C Patients and Interferon Treatm丙型肝炎患者干扰素治疗抑郁症课件.ppt

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in Hepatitis C Patients and Interferon Treatm丙型肝炎患者干扰素治疗抑郁症课件

Depression in Hepatitis C Patients and Interferon Treatment Paul J. Thuluvath, MD, FRCP The Johns Hopkins University School of Medicine Evidence for increased prevalence of depression or associated symptoms (fatigue, reduced quality of life) in patients with HCV Incidence of depression with interferon treatment and its potential impact on successful outcome of treatment for HCV Pathophysiology of interferon (and HCV) induced depression Current role of anti-depressants in interferon related depression Common Neuropsychiatry Symptoms Fatigue Impaired quality of life Cognitive impairment Depression Fatigue Common in HCV – 20 to 80% (versus 20-30% with general population), but similar in HCV positive and negative blood donors No clear relationship between severity of liver disease and depression Conflicting data on improvement after HCV clearance 35% (29 of 83) improvement in responders vs. 22% (75 of 348) in non-responders Cacoub P et al J Hepatol 2002;37:545 No difference between those who had spontaneous clearance vs. chronic carriers Coughlan B et al Br J Health Psychology 2002;7:105 Quality of Life Studies QOL is lower in HCV independent of the severity of liver disease (Ware, 1999; Bonkovsky 1999) QOL is lower in HCV compared to HBV, and it is unrelated to the mode of infection (Foster, 1998) QOL improves after viral eradication (Ware, 1999; Bonkovsky, 1999; McHutchinson, 2001) But QOL is better in those who are unaware of HCV diagnosis (Rodgers, 1999) No difference in QOL in Irish women with HCV RNA positive or negative (Coughlan, 2002) Cognitive Impairment Impairment of attention, concentration, and psychomotor speed in the presence of minimal hepatitis (Forton, DM, et al. Hepatology 2002) Impairment is similar to other liver disease (Hilsabeck, RC, et al. Hepatology 2002) Cerebral choline to creatine ratio elevated in basal ganglia and white matter on MRS in the presence of minimal liver disease (Forton, DM, et al. Lancet 2001) Mechanism unknown: HCV negative