Association of chronic hepatitis C with major depressive disorders: irrespective of interferon-alpha therapy

Mauro G Carta, Maria Carolina Hardoy, Alessandra Garofalo, Enrica Pisano, Valentina Nonnoi, Gesuina Intilla, Giancarlo Serra, Cinzia Balestrieri, Luchino Chessa, Cristiana Cauli, Maria Eliana Lai, Patrizia Farci, Mauro G Carta, Maria Carolina Hardoy, Alessandra Garofalo, Enrica Pisano, Valentina Nonnoi, Gesuina Intilla, Giancarlo Serra, Cinzia Balestrieri, Luchino Chessa, Cristiana Cauli, Maria Eliana Lai, Patrizia Farci

Abstract

Background: Mood and anxiety symptoms in chronic hepatitis C (CHC) may be related to the patient awareness of the diagnosis and prognosis, to side effects induced by interferon (IFN)-alpha treatment, as well as to substance abuse. However, the observation of metabolic alterations in patients with CHC has led to hypothesize a direct effect of hepatitis C virus (HCV) on brain function. This study was aimed at elucidating whether CHC is associated with specific anxiety or mood disorders independently of confounding factors.

Methods: Patient cohort: consecutive patients, 135 with CHC and 76 with chronic hepatitis B (CHB).

Exclusion criteria: previous treatment with IFN-alpha, co-infection with HCV and hepatitis B virus, infection with human immunodeficiency virus, drug or alcohol abuse, or malignancies.

Controls: subjects without evidence of hepatitis randomly extracted from the database of a previous epidemiological study; they were divided into two groups of 540 (332 males) and 304 (220 males) as controls for patients with CHC and CHB, respectively. The psychiatric diagnosis was formulated by means of the Composite International Diagnostic Interview Simplified carried out by a physician according to DSM-IV criteria.

Results: A higher lifetime prevalence of major depressive disorder (MDD) was observed among CHC compared to CHB or controls. The risk of MDD was not statistically different between CHB and controls. Both the CHC and CHB groups showed a significantly higher frequency of panic disorder when compared to controls. No statistical differences were observed in the prevalence of general anxiety disorder and social phobia when CHC or CHB were compared to controls.

Conclusion: The present study provides the first evidence of an association between CHC and MDD, diagnosed on the basis of well-defined international criteria. This association is independent of treatment with IFN-alpha and is not influenced by substance or alcohol abuse. By contrast, anxiety disorders do not appear to be specifically associated with CHC.

References

    1. Forton DM, Thomas HC, Murphy CA, Allsop JM, Foster GR, Main J, Wesnes KA, Taylor-Robinson SD. Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology. 2002;35:433–439. doi: 10.1053/jhep.2002.30688.
    1. Fontana RJ, Hussain KB, Schwartz SM, Moyer CA, Su GL, Lok AS. Emotional distress in chronic hepatitis C patients not receiving antiviral therapy. J Hepatol. 2002;36:401–407. doi: 10.1016/S0168-8278(01)00280-X.
    1. Bonkovsky HL, Woolley JM. Reduction of health-related quality of life in chronic hepatitis C and improvement with interferon therapy. The Consensus Interferon Study Group. Hepatology. 1999;29:264–270. doi: 10.1002/hep.510290124.
    1. Foster GR, Goldin RD, Thomas HC. Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis. Hepatology. 1998;27:209–212. doi: 10.1002/hep.510270132.
    1. Fontana RJ, Moyer CA, Sonnad S, Lok ASF, Sneed-Pee N, Walsh J, Klein S, Webster S. Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C. Am J Gastroenterol. 2001;96:170–178. doi: 10.1111/j.1572-0241.2001.03473.x.
    1. Grassi L, Satriano J, Serra A, Biancosino B, Zotos S, Sighinolfi L, Ghinelli F. Emotional stress, psychosocial variables and coping associated with hepatitis C virus and human immunodeficiency virus infections in intravenous drug users. Psychother Psychosom. 2002;71:342–349. doi: 10.1159/000065993.
    1. Huebschmann H. On transference in the treatment of organic diseases. Psychother Psychosom. 1979;31:288–293.
    1. Ranjith G. Interferon-alpha-induced depression: when a randomized trial is not a randomized controlled trial. Psychother Psychosom. 2005;74:387. doi: 10.1159/000087787.
    1. Forton DM, Allsop JM, Main J, Foster GR, Thomas HC, Taylor-Robinson SD. Evidence for a cerebral effect of the hepatitis C virus. Lancet. 2001;358:38–39. doi: 10.1016/S0140-6736(00)05270-3.
    1. Alvarado Esquivel C, Arreola Valenzuela MA, Mercado Suárez MF, Espinoza Andrade F. Hepatitis B virus infection among inpatients of a psychiatric hospital of Mexico. Clin Pract Epidemol Ment Health. 2005;1:10. doi: 10.1186/1745-0179-1-10.
    1. Carta MG, Hardoy MC, Cadeddu M, Carpiniello B, Dell'Osso L, Reda MA, Wittchen HU. Social Phobia in an Italian region: do Italian studies show lower frequencies than community surveys conducted in other European countries? BMC Psychiatry. 2004;4:31. doi: 10.1186/1471-244X-4-31.
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th.American Psychiatric Association; Washington, DC; 1994.
    1. Miettinen O. Confounding and effect – modification. Am J Epidemiol. 1974;100:350–353.
    1. Fontana RJ, Schwartz SM, Gebremariam A, Lok AS, Moyer CA. Emotional distress during interferon-alpha-2B and ribavirin treatment of chronic hepatitis C. Psychosomatics. 2002;43:378–385. doi: 10.1176/appi.psy.43.5.378.
    1. Kramer L, Bauer E, Funk G, Hofer H, Jessner W, Steindl-Munda P, Wrba F, Madl C, Gangl A, Ferenci P. Subclinical impairment of brain function in chronic hepatitis C infection. J Hepatol. 2002;37:349–354. doi: 10.1016/S0168-8278(02)00172-1.
    1. Aznar-Bueno C, Abad-Alegría F, Amiguet JA. Early detection of neurophysiological abnormalities in infection by human immunodeficiency virus. Clin Electroencephalogr. 2000;31:116–121.
    1. Chang L, Ernst T, Witt MD, Ames N, Gaiefsky M, Miller E. Relationships among brain metabolites, cognitive function, and viral loads in antiretroviral-naive HIV patients. Neuroimage. 2002;17:1638–48. doi: 10.1006/nimg.2002.1254.
    1. Tarasow E, Wiercinska-Drapalo A, Kubas B, Dzienis W, Orzechowska-Bobkiewicz A, Prokopowicz D, Walecki J. Cerebral MR spectroscopy in neurologically asymptomatic HIV-infected patients. Acta Radiol. 2003;44:206–212. doi: 10.1034/j.1600-0455.2003.00028.x.
    1. Chang L, Lee PL, Yiannoutsos CT, Ernst T, Marra CM, Richards T, Kolson D, Schifitto G, Jarvik JG, Miller EN, Lenkinski R, Gonzalez G, Navia BA. HIV MRS Consortium: A multicenter in vivo proton-MRS study of HIV-associated dementia and its relationship to age. Neuroimage. 2004;23:1336–1347. doi: 10.1016/j.neuroimage.2004.07.067.
    1. Thomas HC, Torok ME, Forton DM, Taylor-Robinson SD. Possible mechanisms of action and reasons for failure of antiviral therapy in chronic hepatitis C. J Hepatol. 1999;31(Suppl 1):152–159. doi: 10.1016/S0168-8278(99)80393-6.
    1. Gowans EJ. Distribution of markers of hepatitis C virus infection throughout the body. Semin Liver Dis. 2000;20:85–102. doi: 10.1055/s-2000-9503.
    1. Radkowski M, Wilkinson J, Nowicki M, Adair D, Vargas H, Ingui C, Rakela J, Laskus T. Search for hepatitis C virus negative-strand RNA sequences and analysis of viral sequences in the central nervous system: evidence of replication. J Virol. 2002;76:600–608. doi: 10.1128/JVI.76.2.600-608.2002.

Source: PubMed

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