Depression in Korean immigrants with hepatitis B and related liver diseases

Oxidative Stress-Induced Liver Damage and Remodeling of the Liver Vasculature

As an organ critically important for targeting and clearing viruses, bacteria, and other foreign material, the liver operates via immune-tolerant, anti-inflammatory mechanisms indispensable to the immune response. Stress and stress-induced factors disrupt the homeostatic balance in the liver, inflicting tissue damage, injury, and remodeling. These factors include oxidative stress (OS) induced by viral infections, environmental toxins, drugs, alcohol, and diet. A recurrent theme seen among stressors common to multiple liver diseases is the induction of mitochondrial dysfunction, increased reactive oxygen species expression, and depletion of ATP. Inflammatory signaling additionally exacerbates the condition, generating a proinflammatory, immunosuppressive microenvironment and activation of apoptotic and necrotic mechanisms that disrupt the integrity of liver morphology. These pathways initiate signaling pathways that significantly contribute to the development of liver steatosis, inflammation, fibrosis, cirrhosis, and liver cancers. In addition, hypoxia and OS directly enhance angiogenesis and lymphangiogenesis in chronic liver diseases. Late-stage consequences of these conditions often narrow the outcomes for liver transplantation or result in death. This review provides a detailed perspective on various stress-induced factors and the specific focus on role of OS in different liver diseases with special emphasis on different molecular mechanisms. It also highlights how resultant changes in the liver vasculature correlate with pathogenesis.

Mei-Gin Formula Ameliorates Obesity through Lipolysis, Fatty Oxidation, and Thermogenesis in High-Fat Diet-Induced Obese Rats

Obesity is a metabolic dysfunction characterized by excessive body fat deposition as a consequence of an energy imbalance. Novel therapeutic strategies have emerged that are safe and have comparatively low side effects for obesity treatment. Functional foods and nutraceuticals have recently received a great deal of attention because of their components with the properties of antimetabolic syndrome. Based on our previous in vitro and in vivo investigations on anti-adipogenesis activity and improved body fat accumulation in serials, the combination of three ingredients (including bainiku-ekisu, black garlic, and Mesona procumbens Hemsl), comprising the Mei-Gin formula (MGF), was eventually selected as a novel inhibitor that exhibited preventive effects against obesity. Herein, we verify the anti-obesity effects of MGF in obese rats induced by a high-fat diet and discuss the potential molecular mechanisms underlying obesity development. Oral administration of MGF significantly suppressed the final body weight, weight change, energy and water intake, subcutaneous and visceral fat mass, liver weight, hepatic total lipids and triglycerides (TG), and serum levels of TG, triglycerides (TC), low-density lipoprotein cholesterol (LDL-C), alanine transaminase (AST), uric acid, and ketone bodies and augmented fecal total lipids, TG, and cholesterol excretion in the high-dose MGF-supplemented groups. Furthermore, the corresponding lipid metabolic pathways revealed that MGF supplementation effectively increased lipolysis and fatty acid oxidation gene expression and attenuated fatty acid synthesis gene expression in the white adipose tissue (WAT) and liver and it also increased mitochondrial activation and thermogenic gene expression in the brown adipose tissue (BAT) of rats with obesity induced by a high-fat diet (HFD). These results demonstrate that the intake of MGF can be beneficial for the suppression of HFD-induced obesity in rats through the lipolysis, fatty oxidation, and thermogenesis pathway. In conclusion, these results demonstrate the anti-obesity efficacy of MGF in vivo and suggest that MGF may act as a potential therapeutic agent against obesity.

Hepatitis B Virus-Associated Hepatocellular Carcinoma and Chronic Stress

The Hepatitis B virus is one of the most significant hepatocarcinogens globally. The carcinogenic mechanisms of this virus are complex, and may include interactions with the host’s immune system. Certain factors, such as stress on the body, can also potentiate these mechanisms. Stress, although adaptive in an acute form, is deleterious to health when chronic and can both suppress and activate the host’s defense system. In hepatocellular carcinoma, this can lead to tumor initiation and progression. Those that are more prone to stress, or exposed to situations that incite stress, may be at higher risk of developing cancer. Racial disparities, for example, are a source of chronic psychosocial stress in America and predispose minorities to poorer outcomes. As it remains perplexing why some individuals with chronic hepatitis B develop feared complications while others do not, it is important to recognize as many risk factors as possible, including those often overlooked such as chronic stress.

The Association between Modifiable Lifestyle Behaviors and Depression among Asian Americans with Chronic Hepatitis B by Medication Status

Asian Americans are disproportionately affected by chronic hepatitis B (CHB), with incidence and mortality rates well above those experienced by non-Hispanic white populations. The goal of this study was to examine the association between depression and modifiable lifestyle behaviors among Asian Americans with CHB, with a comparison between those on hepatitis medication and those not on medication. In total, 313 Asian Americans with CHB were recruited through outpatient clinics and community-based organizations to participate in an in-person baseline assessment. We collected data on participants’ sociodemographic characteristics, health-related behaviors, depression symptoms, and modifiable lifestyle behaviors. Bivariate analyses (two sample t-test and chi-square test of independence) and multivariable logistic regression were conducted. We found a high prevalence of depression among individuals living with CHB (41.81% among those not on antiviral medication and 39.71% among those on medication). Multivariate logistic regression results showed that Chinese ethnicity (vs. Vietnamese) and lack of physical activity were significantly associated with a higher risk of mild/severe depression, regardless of medication status. However, the protective effect of physical activity was strong for those on antiviral medication. Furthermore, being employed was significantly associated with a lower risk for depression among Asian Americans on medication, while younger age and being currently married were significantly associated with lower risk of depression among those not on medication. Our findings highlight the significance of physical activity among Asian Americans with CHB, especially for those on antiviral medication. Future prospective research efforts are needed to better identify the potential behavioral mechanisms of depression and provide insights for the psychopharmacological management in this vulnerable population.

High risk of drug toxicity in social isolation stress due to liver dysfunction: Role of oxidative stress and inflammation

BACKGROUND

Previous studies have shown that social isolation stress (SIS) could associate with several systemic diseases; however, the role of SIS on liver dysfunction has yet to be established. This study aimed to investigate the effect of SIS on liver function and possible drug toxicity through liver inflammation and oxidative stress.

METHODS

Male Naval Medical Research Institute mice in two groups of SIS and control were treated with typical anti-depressant and anxiolytic agents including fluoxetine, norfluoxetine, desipramine, and imipramine in both groups. Then blood concentrations (or their active metabolites) of these drugs were assessed. Liver function test, including aspartate transaminase (AST), alanine aminotransferase (ALT), total bilirubin, and conjugated bilirubin), oxidative activity, inflammatory cytokines, and the gene expression of cytochrome P450 enzymes were assessed.

RESULTS

We observed that the liver enzymes including AST and ALT was slightly higher in SIS animals. The blood concentrations of fluoxetine, norfluoxetine, desipramine, and imipramine were significantly higher in SIS animals. The gene expression of CYP1A2, CYP2A6, CYP2C9, CYP2C29, and CYP2D were significantly decreased in SIS animals. Our results showed that SIS animals had significantly higher level of tumor necrosis factor-α, interleukin-1β, and interleukin-6. SIS could significantly decrease the activity of antioxidant agent (Glutathione).

CONCLUSION

We hypothesized that SIS could induce liver dysfunction and decrease the rate of drug clearance through liver inflammation and oxidative stress; therefore, the blood concentration of anti-depressant/anxiolytic agents should closely monitor in SIS due to the high toxicity of these agents.

Acceleration of TAA-Induced Liver Fibrosis by Stress Exposure Is Associated with Upregulation of Nerve Growth Factor and Glycopattern Deviations

Liver fibrosis results from many chronic injuries and may often progress to cirrhosis and hepatocellular carcinoma (HCC). In fact, up to 90% of HCC arise in a cirrhotic liver. Conversely, stress is implicated in liver damage, worsening disease outcome. Hence, stress could play a role in disrupting liver homeostasis, a concept that has not been fully explored. Here, in a murine model of TAA-induced liver fibrosis we identified nerve growth factor (NGF) to be a crucial regulator of the stress-induced fibrogenesis signaling pathway as it activates its receptor p75 neurotrophin receptor (p75NTR), increasing liver damage. Additionally, blocking the NGF decreased liver fibrosis whereas treatment with recombinant NGF accelerated the fibrotic process to a similar extent than stress challenge. We further show that the fibrogenesis induced by stress is characterized by specific changes in the hepatoglycocode (increased β1,6GlcNAc-branched complex N-glycans and decreased core 1 O-glycans expression) which are also observed in patients with advanced fibrosis compared to patients with a low level of fibrosis. Our study facilitates an understanding of stress-induced liver injury and identify NGF signaling pathway in early stages of the disease, which contributes to the established fibrogenesis.

Hepatitis B-related hepatocellular carcinoma and stress: untangling the host immune response from clinical outcomes

Chronic hepatitis B virus (HBV) infection is a major public health challenge on the global scale. Affecting hundreds of millions worldwide, HBV is a leading risk factor for hepatocellular carcinoma (HCC). Clinical outcomes from chronic HBV infection are varied and appear to be influenced by a complex and dysregulated host immune response. In turn, much attention has been given to the immunologic response to HBV in an effort to identify host factors that lead to the development of HCC. However, the role of nonimmunologic host factors, such as chronic stress, in HBV-related HCC is poorly defined. Indeed, a growing appreciation for the effects of stress on chronic liver diseases raises the question of its role in chronic HBV infection. In this light, the present review will untangle the roles of key host factors in HBV-related HCC with an emphasis on chronic stress as a viable contributor. First discussed is the interplay of stress, inflammation and chronic liver disease. The host immune response's role as a driver of HBV-related HCC is then reviewed, allowing for a close exploration of the effects of stress on immune function in chronic hepatitis B and as a potential risk factor for HBV-related HCC.

Cross-sectional association between long working hours and liver function: the Kangbuk Samsung Health Study

OBJECTIVES

Although the effects of long working hours on liver function remain unclear, in South Korea, there is a social perception that long working hours are associated with poor liver function. Thus, long working hours have recently become a major issue. This study aimed to determine the association between long working hours and liver function, as indicated by the alanine transaminase (ALT) levels.

DESIGN

Cross-sectional study.

SETTING

Large university hospitals in Seoul and Suwon, South Korea.

PARTICIPANTS

Workers in formal employment who underwent a comprehensive health examination at the Kangbuk Samsung Hospital Total Healthcare Centre clinics in Seoul and Suwon, South Korea, between January 2011 and December 2018. Of the 386 488 participants, 212 421 met the inclusion criteria and were included in the analysis.

PRIMARY OUTCOME MEASURE

ALT elevation.

RESULTS

The participants were predominantly well-educated (86.1%), male (69.3%) and in their 30s (49.6%). In total, 13.4% of the participants presented ALT elevation (>40 IU/L). There was no significant association between working hours and ALT elevation in the general population and in the hepatitis B surface antigen (HBsAg)-negative group. Conversely, in the HBsAg-positive group, working >60 hours per week compared with 35-40 hours per week was significantly associated with ALT elevation. The association was more pronounced in those with ALT levels >80 IU/L (OR 1.94, 95% CI 1.24 to 3.01) than in those with ALT levels >40 IU/L (OR: 1.45, 95% CI 1.20 to 1.75). The p values for trend were <0.05.

CONCLUSIONS

Long working hours were associated with ALT elevation only in hepatitis B virus carriers and not in the general population. Provided that there is adherence to the legal working hours, there is no need to further restrict working hours for liver health, irrespective of HBsAg status.

An Herbal Formula CGplus Ameliorates Stress-Induced Hepatic Injury in a BALB/c Mouse Model

Introduction

Stress is a well-known factor for inflammation in diverse organs/tissues. Stress also leads to liver injury, which was supported by clinical observations and animal studies. We herein investigated the hepatoprotective property of an herbal formula (called as CG^plus) consisting of Artemisia gmelinii Weber ex Stechm. (syn, Artemisia iwayomogi Kitamura), Wurfbainia villosa var. xanthioides (Wall. ex Baker) Skornick. & A.D.Poulsen (syn, Amomum xanthioides Wallich), and Salvia miltiorrhiza Bunge against stress-induced hepatic damage.

Methods

Male BALB/c mice were orally administered water extract of CG^plus (0, 50, 100, or 200 mg/kg) daily for 5 days, and then subjected to immobilization stress for 6 h on the 5^th day.

Results

Acute immobilization stress elevated remarkably serum concentrations of stress hormones (corticosterone and adrenaline) and two hepatic injury parameters (ALT and AST), while these alterations were significantly attenuated by the administration of CG^plus. The increases of oxidative parameters (ROS, NO, lipid peroxidation, and protein carbonyl) and deviation of IL-1β and IL-10 in opposite directions in hepatic tissues were significantly normalized by CG^plus. Pre-treatment with CG^plus also notably ameliorated the abnormal activation of toll-like receptor 4 (TLR4), CD14, and lipopolysaccharide-binding protein (LPB) as well as infiltration of neutrophils in hepatic tissues.

Conclusion

These results suggest that an herbal formula (CG^plus) derived from traditional pharmaceutical theory has a potent protective effect against stress-induced hepatic injury via regulation of pro- (IL-1β) and anti-inflammatory (IL-10) cytokines.

Psychiatric Morbidity, Fatigue, Stigma and Quality of Life of Patients With Hepatitis B Infection

AIMS

This study aimed to evaluate the prevalence of psychiatric morbidity, fatigue, stigma and quality of life (QOL) of patients with hepatitis B infection. Additional aim of the study was to evaluate the correlates of psychiatric morbidity and QOL in patients with hepatitis B infection.

METHODS

A total of 150 patients with hepatitis B virus (HBV) infection (75 inactive carriers and 75 patients with chronic hepatitis) were evaluated on Mini International Neuropsychiatric Interview-PLUS, World Health Organization-QOL-BREF scale, Chronic Liver Disease Questionnaire, Toronto Chinese HBV Stigma Scale, HBV knowledge scale and Fatigue Severity scale.

RESULTS

About half of the study participants (49.3%) had at least one lifetime psychiatric morbidity and of these more than one-third (37.3%) fulfilled at least one current psychiatric diagnosis. Generalized anxiety disorder was seen in 19.3% of the participants. Major depressive disorder was the second most common psychiatric diagnosis fulfilled at the time of assessment, with nearly equal prevalence of first episode of depression (8%) and recurrent depressive disorder (7.3%). Compared to those with inactive hepatitis, patients in the chronic hepatitis group had poorer QOL and experienced more fatigue. However, both the groups did not differ in terms of knowledge and stigma. Compared to those without current or lifetime psychiatric diagnosis, those with current or lifetime psychiatric diagnosis had poorer QOL, higher level of stigma and higher fatigue scale.

CONCLUSION

About half of the patients with HBV infection have psychiatric morbidity, which has negative impact on QOL of patients. Hence, it is important to recognize psychiatric morbidity among patients with HBV.

A literature review for the mechanisms of stress-induced liver injury

INTRODUCTION

Experimental studies and clinical observations have shown that stress can damage hepatic tissue both directly and indirectly. Many studies have partially revealed the contributors of stress-induced liver injury; however, the whole process has not yet been uncovered. This review aims to summarize the mechanisms that have been proposed to be involved.

METHODS

A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed) in its entirety up to March 2018, and analyzed the animal-derived mechanistic studies on stress-induced liver injury.

RESULTS

The liver is the organ that meets and filters a mass of alien material, and then maintains immune tolerance under physiological conditions. Under stress conditions, however, immune tolerance is interrupted, which results in the induction of inflammation in the liver. Contributors to this process can be categorized as follows: hypoxia-reoxygenation, over-activation of Kupffer cells and oxidative stress, influx of gut-derived lipopolysaccharide and norepinephrine, and over-production of stress hormones and activation of the sympathetic nerve.

CONCLUSIONS

Psychological stress is associated with a variety of pathological conditions resulting in liver injury through multiple systems, including the sympathetic nervous and adrenocortical system. Mechanistic understanding of this phenomenon is important for the clinical practice of managing patients with hepatic disorders and should be explored further in the future.

Anxiety and depression are associated with long-term outcomes of hepatocellular carcinoma: A nationwide study of a cohort from Taiwan

OBJECTIVES

A natural experimental design was coupled with propensity score matching to assess the risks of anxiety and depression and to assess the longitudinal effects of anxiety and depression on healthcare utilisation and mortality in hepatocellular carcinoma (HCC) patients.

METHODS

This nationwide population-based cohort study retrospectively analysed 7304 patients treated for HCC during 1996-2010. Generalised estimating equations were used to estimate differences-in-differences models for examining the effects of anxiety and depression disorders.

RESULTS

Independent risk factors for anxiety and depression in the HCC patients were female gender (hazard ratio (HR) 1.45; P < 0.001), Charlson co-morbidity index score (HR 1.12; P = 0.005), and liver cirrhosis (HR 1.35; P = 0.004). Anxiety and depression (differences-in-differences value) had a significant (P < 0.001) positive net effect on number of physician visits. Furthermore, the mean overall survival time was 83.4 months (SD 5.4 months) in the anxiety/depression group and 65.4 months (SD 4.8 months) in the non-disorder group. Additionally, the overall survival rate was significantly higher in the anxiety/depression group compared to the non-disorder group during the study period (P = 0.003).

CONCLUSIONS

Anxiety disorders and depression disorders are associated with a significantly increased overall survival rate in HCC patients. However, further studies are needed to investigate this association.

Quality of life of hepatitis B virus surface antigen-positive patients with suppressed viral replication: comparison between inactive carriers and nucleot(s)ide analog-treated patients

OBJECTIVE

Hepatitis B virus infection is a relevant health problem with more than 400 million infected people worldwide. Our aim was to analyze quality of life of hepatitis B virus surface antigen-positive patients in inactive status or treated with antivirals.

PATIENTS AND METHODS

Patients referred to our center between February and October 2016 were prospectively enrolled. Half-structured interview was used for examining psychological symptoms and Illness Behavior Questionnaire for exploring attitudes toward illness. We used World Health Organization Quality of Life-short version survey for studying quality of life and logistic regression to find possible predictors of nonadequate quality of life.

RESULTS

The study involved 102 patients. At Illness Behavior Questionnaire test, psychological perception of illness (21.6%), and denial of illness itself (13.7%) were the most frequent conditions. Inactive and treated subgroups were comparable for almost all variables and scores, but patients on treatment were significantly more often male, older, and cirrhotic. Sleep disturbance emerged as an independent predictor of inadequate quality of life in Physical health, anxiety in Social relationship, and both anxiety and hostility in Environmental health domain.

CONCLUSION

Inactive carriers and patients on treatment showed the same global quality of life, but the second group was older and more frequently with an advanced liver disease. Further studies might specifically evaluate the impact of antiviral therapy on quality of life.

Stress resilience and cancer risk: a nationwide cohort study

Background

Stress resilience is recognised as a determinant of both psychiatric and somatic health, but the potential link between stress resilience and cancer development has not been explored.

Methods

In this nationwide cohort study, we examined the association between stress resilience in adolescence and subsequent cancer risk. We identified a cohort of 284 257 Swedish men, born 1952–1956, who underwent compulsory military enlistment examinations including measures of psychological stress resilience (median age 18 years). The resulting score was categorised as low, moderate and high stress resilience. Individuals diagnosed with cancer during the follow-up time were identified through data linkage to the Swedish Cancer Register.

Results

Lowest stress resilience, compared with the highest, was associated with increased risks of liver (HR: 4.73, 95% CI 2.73 to 8.19) and lung (HR: 2.75, 95% CI 2.02 to 3.74) cancer after adjusting for markers of socioeconomic circumstances in childhood (p for trend <0.001 for both cancer types). Further adjustment for cognitive and physical fitness at conscription assessment had a marginal influence. In contrast, men with low stress resilience had a decreased risk of being diagnosed with prostate cancer (HR: 0.65, 95% CI 0.56 to 0.76) and malignant melanoma (HR: 0.65, 95% CI 0.55 to 0.76).

Conclusion

We conclude that adolescent stress resilience, plausibly by influencing behavioural choices and social patterns, constitutes an important determinant of adult cancer occurrence. Increased awareness of long-term consequences in susceptible individuals may help direct future efforts to reduce cancer burden in adults.

Prevalence of Major Depression and Its Associations With Demographic and Clinical Characteristics and Quality of Life in Chinese Patients With HBV-related Liver Diseases

BACKGROUND

There are no data about the frequency of major depression in patients with liver disease related to Hepatitis B virus (HBV) in China. This study examined the prevalence of major depression and its clinical correlates and association with quality of life (QOL) in patients with HBV-related liver diseases.

METHOD

Altogether 634 patients with HBV-related liver diseases met study entry criteria and completed the survey. The diagnosis of major depression was established with the Mini International Neuropsychiatric Interview (MINI). Socio-demographic and clinical characteristics, Global Assessment of Functioning (GAF) and QOL were measured.

RESULTS

The prevalence of major depression was 6.4%. Multivariable logistic regression analyses revealed that insomnia (P=0.01, OR=5.5, 95%CI=1.4-21.6) and global functioning (P<0.001, OR=0.6, 95% CI=0.5-0.7) were independently associated with major depression. Major depression was associated with both poor physical (F _{(1, 634)}=4.0, P=0.04) and mental QOL (F _{(1, 634)}=26.2, P<0.001).

CONCLUSIONS

Given the negative impact of depression on patients' QOL, more attempts should be made to identify and treat it in HBV-related diseases.

Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms?

The occurrence of depression is higher in patients with chronic liver disease (CLD) than that in the general population. The mechanism described in previous studies mainly focused on inflammation and stress, which not only exists in CLD, but also emerges in common chronic diseases, leaving the specific mechanism unknown. This review was to summarize the prevalence and risk factors of depression in CLD including chronic hepatitis B, chronic hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, and to point out the possible underlying mechanism of this potential link. Clarifying the origins of this common comorbidity (depression and CLD) may provide more information to understand both diseases.

The Psychometric Properties of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) in Patients with HBV-Related Liver Disease

BACKGROUND

Comorbid depression in Hepatitis B virus (HBV) is common. Developing accurate and time- efficient tools to measure depressive symptoms in HBV is important for research and clinical practice in China.

AIMS

This study tested the psychometric properties of the Chinese version of the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR) in HBV patients.

METHODS

The study recruited 245 depressed patients with HBV and related liver disease. The severity of depressive symptoms was assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) and the QIDS-SR.

RESULTS

Internal consistency (Cronbach's alpha) was 0.796 for QIDS-SR. The QIDS-SR total score was significantly correlated with the MADRS total score (r=0.698, p<0.001). The QIDS-SR showed unidimensional measurement properties in exploratory factor analysis.

CONCLUSIONS

The QIDS-SR (Chinese version) has good psychometric properties in HBV patients and appears to be useful in assessing depression in clinical settings.

Health-related quality of life in patients with chronic hepatitis B during antiviral treatment and off-treatment

INTRODUCTION

Health-related quality of life (HRQoL) has emerged as an important consideration in the care of patients with chronic hepatitis B (CHB). However, whether benefits from the improved HRQoL that occurs after antiviral treatment or drug discontinuation outweigh the risks of viral relapse is an unanswered question. The aim of this study was to evaluate the HRQoL among patients with CHB during antiviral treatment and withdrawal of treatment.

PATIENTS AND METHODS

There were 102 patients who met the enrollment criteria with 54 patients in the treatment group and 48 patients in the discontinuation group. Sociodemographic information was collected. The 36-Item Short-Form Health Survey (SF-36), European Quality of Life-5 Dimensions, and Beck Depression Inventory (BDI) were adopted to evaluate life quality and mental health.

RESULTS

In the treatment group, SF-36 showed that the physical functions were significantly increased. In the discontination group, the psychological functions showed improvement. A multivariate regression analysis indicated that baseline SF-36 score was a predictor for improvement in HRQoL (odds ratio =1.17, P=0.003) and baseline BDI score was a factor for remission of depression (odds ratio =0.75, P=0.005) after medical intervention. When the cutoff value of SF-36 score was set at 79.5, the sensitivity and specificity to predict improvement in HRQoL were 82.8% and 74.0%, respectively. When the cutoff value of BDI was found as 8.5, the sensitivity and specificity to predict alleviation of depression were 58.6%, and 76.0%, respectively.

CONCLUSION

Antiviral treatment benefits the physical health of the patients with CHB, while conferring no obvious improvement in their psychological condition. Improved psychological interventions for patients with CHB, especially for those with lower baseline SF-36 scores and higher BDI scores, may improve their quality of life.

Hepatitis B-Related Concerns and Anxieties Among People With Chronic Hepatitis B in Australia

BACKGROUND

The psychological wellbeing of people with chronic hepatitis B (CHB) may be negatively affected due to the chronic and transmissible nature of the disease, and possible serious complications (e.g. cirrhosis and liver cancer). There are limited data investigating concerns and anxieties among people living with CHB.

OBJECTIVES

This study examined feelings about having hepatitis B among people with CHB, including hepatitis B-related concerns and anxieties.

PATIENTS AND METHODS

Using convenience sampling, people with CHB attending four public liver clinics and one general practice in three Australian jurisdictions between April and September 2013 completed a self-administered questionnaire about their feelings about having hepatitis B.

RESULTS

Ninety-three people completed the survey. Mean age was 45 years, 57% were men, and 93% were born overseas (75% from Asia). Seventy-six percent of participants reported having hepatitis B-related concerns and anxieties. The most common concerns were of developing liver cancer (57%), and infecting other people (53%). Thirty-five percent of participants were unwilling to talk to anyone about their hepatitis B while 25% changed how they lived as a result of having hepatitis B. Lower educational level was associated with feeling scared of hepatitis B (adjusted Odds Ratio [OR]: 4.04; 95%CI: 1.09, 14.90; P = 0.04), and an unwillingness to talk to anyone about hepatitis B (adjusted OR: 4.41; 95%CI: 1.09, 17.83; P = 0.04). Very good English proficiency was associated with a higher likelihood of participants changing how they lived (adjusted OR: 12.66; 95%CI: 2.21, 72.42; P < 0.01), and seeing life differently as a result of having hepatitis B (adjusted OR: 21.10; 95%CI: 3.70, 120.19; P < 0.01). Health professionals were the key person for 34% of participants in helping them cope with having hepatitis B, while 18% reported that no one supported them.

CONCLUSIONS

Hepatitis B-related concerns and anxieties are prevalent among people with CHB. Clinical management of people with CHB must address their psychological support needs as an essential component of comprehensive care.

Somatosensory Amplification, Anxiety, and Depression in Patients With Hepatitis B: Impact on Functionality

In the present study, we aimed to determine the differences in body image along with anxiety and depression levels, and also to evaluate their impact on disability parameters in patients with hepatitis B.Our study comprised 77 patients with hepatitis B (n = 41, chronic active patients; n = 36, patients with inactive hepatitis B) and 53 healthy individuals (control group). Enrolled patients responded to several questionnaires, including a sociodemographic form, Sheehan Disability Scale (SDS), Hospital Anxiety and Depression Scale (HADS), and Somatosensory Amplification Scale.Patients with chronic active hepatitis B (CAHB) had higher levels of somatosensory perception than patients with inactive hepatitis B (IHB) and control group (P < 0.001, P = 0.001, respectively). Patients with CAHB had high scores on all the 3 domains of SDS (work/school, P < 0.001; social life, P < 0.001; and family life, P < 0.001). Also, patients with CAHB had a significantly higher HADS total score, HADS anxiety score, and HADS depression score than control group (P < 0.001, P < 0.001, P < 0.001, respectively). No significant difference was noted between patients with CAHB and patients with IHB with regard to HADS depression score; however, HADS anxiety and HADS total scores were significantly higher in the CAHB group (NS, P = 0.027, P = 0.035, respectively). Moreover, the IHB group exhibited higher scores for the work/school and social life domains of SDS than those of the control group (P = 0.008, P = 0.047).Although patients with CAHB may present with somatosensory amplification, anxiety, and depression, patients with IHB do not exhibit such symptoms. However, functionality is affected in both carrier and active patient groups. We believe that routine health checks of patients with hepatitis B should include psychiatric evaluation, psychiatric examination, and follow-up.

Health-related quality of life among blood donors with hepatitis B and hepatitis C: longitudinal study before and after diagnosis

Introduction

There is evidence that patients suffering from chronic hepatic diseases, including chronic hepatitis B and chronic hepatitis C, have a reduced health-related quality of life. The aim of this study was to evaluate the impact of the notification of test results for hepatitis B and hepatitis C on the quality of life of blood donors.

Methods

Over a 29-month period, this study assessed the quality of life of 105 blood donors with positive serological screening tests for hepatitis B and hepatitis C and donors who presented false-positive test results. The Medical Outcome Study 36-Item Short Form Health Survey Questionnaire was applied at three time points: (1) when an additional blood sample was collected for confirmatory tests; (2) when donors were notified about their serological status; and (3) when donors, positive for hepatitis B and hepatitis C, started clinical follow-up. Quality of life scores for the confirmed hepatitis B and hepatitis C groups were compared to the false-positive control group.

Results

The domains bodily pain, general health perception, social function, and mental health and the physical component improved significantly in donors with hepatitis C from Time Point 1 to Time Point 3. Health-related quality of life scores of donors diagnosed with hepatitis B and hepatitis C were significantly lower in six and four of the eight domains, respectively, compared to the false-positive control group.

Conclusion

A decreased quality of life was detected before and after diagnosis in blood donors with hepatitis B and hepatitis C. Contrary to hepatitis B positive donors, the possibility of medical care may have improved the quality of life among hepatitis C positive donors.

Prevalence and severity of depression in chronic viral hepatitis in Iran

Aim: The aim of this study was to compare the prevalence and severity of depression in chronic hepatitis B (CHB) patients, chronic hepatitis C (CHC) patients, and healthy participants.

Methods: Two hundred and fifty-three persons participated in this cross-sectional study between 2011 and 2012 in Imam Khomeini Hospital. The prevalence and severity of depression were assessed using the Hamilton Scale.

Results: There was significantly higher prevalence of depression in CHC patients (35.9%) than in healthy participants (11.3%) and CHB patients (19.8%) (both P < 0.01). However, CHB and CHC patients did not differ significantly in their depression prevalence after excluding inactive hepatitis B surface antigen (HBsAg) carriers (29.3% vs. 35.9%; P > 0.05). Inactive HBsAg carriers differed significantly from CHB patients—excluding inactive HBsAg carriers—in depression prevalence (10.0% vs. 29.3%; P < 0.05). No statistically significant difference was found in depression severity between all groups (P > 0.05).

Conclusion: Depression screening in chronic hepatitis B and chronic hepatitis C patients may be beneficial in disease management.

Physiological and subjective responses after psychosocial stress in Chinese hepatitis B patients

Compared with healthy participants, Chinese patients with hepatitis B (HB) experience more psychosocial stress. The present study provided the first examination of physiological and subjective responses to stress in Chinese HB patients. A standard psychosocial stressor, the Trier Social Stress Test (TSST), was administered to 26 Chinese HB patients and 24 healthy control participants. Cortisol concentrations were measured in blood samples collected before and after the stressor. Self-reported emotional responses and cardiovascular measures were examined before and after the TSST. Depression and anxiety were assessed using Hospital Anxiety and Depression Scale. Chinese HB patients exhibited higher cortisol response to the stressor than healthy control participants. Compared with healthy participants, Chinese HB patients showed higher levels of anxiety, depression and nervousness, and lower levels of calmness after the TSST. HB patients reported more negative life events in the previous 6 months and obtained higher adversity scores, as compared with control participants. Significant correlations were obtained between adversity scores and change cortisol secretion after TSST in HB patients, but not in healthy participants. This study firstly demonstrates that physiological and subjective responses to psychosocial stress among Chinese HB patients were different from that in healthy control participants.

Association of chronic liver disease with depression: a population-based study

OBJECTIVE

Chronic liver diseases (CLD) have been associated with depression. Our aim was to assess the association of different types of CLD with depression in a population-based cohort.

METHODS

We examined data from National Health and Nutrition Examination Survey (NHANES 2005-2010). We included adult patients with chronic hepatitis C (CH-C), chronic hepatitis B (CH-B), alcohol-related liver disease (ALD), and nonalcoholic fatty liver disease (NAFLD). Patient Health Questionnaire (PHQ-9) survey was used as a depression screener. Univariate and multivariate analyses were performed to determine independent variables associated with each type of CLD and depression.

RESULTS

The cohort included 10,231 NHANES participants. After multivariate analysis, CH-C was independently associated with age (OR = 1.05, 95% CI: 1.03-1.07), male gender (OR = 1.88, 95% CI: 1.19-2.97), African American race/ethnicity (OR = 2.50, 95% CI:1.50-4.18), smoking (OR = 6.20, 95% CI: 1.62-23.68), injection drug use (OR = 52.86, 95% CI:32.87-85.03), and depression (OR = 2.87, 95% CI: 1.78-4.62). CH-B was independently associated with being non-Caucasian (for African Americans OR = 5.09, 95% CI: 2.41-10.76, for other races OR = 4.74, 95% CI: 2.32-9.70). ALD was independently associated with younger age (OR = 0.98, 95% CI: 0.96-0.99), male gender (OR = 1.53, 95% CI: 1.19-1.95), Mexican American race/ethnicity (OR = 2.63, 95% CI: 1.87-3.69), and moderate to heavy smoking (OR = 2.08, 95% CI: 1.46-2.96). Finally, presence of insulin resistance [OR = 2.65 95% CI: 1.98-3.55], diabetes [OR = 1.54 95% CI: 1.11-2.13], and Mexican American race/ethnicity [OR = 2.03(1.35-3.06)], were predictive of NAFLD.

CONCLUSIONS

Although depression has been suspected to be associated with a number of CLD, this association remains strong only for CH-C.

A revolutionary road: an analysis of persons living with hepatitis B in China

This study explores the interactions of the environmental barriers, coping behaviors, and personal characteristics of persons living with hepatitis B in China within the framework of Bandura's social cognitive theory. An analysis of 1,607 messages from an online support group revealed multiple barriers including institutional discrimination, relationship difficulty, alcohol-drinking social norm, limitations of the health care system and pharmaceutical market, and financial constraints. Major coping behaviors were identified as seeking health and reproductive advice, avoiding disclosure and discrimination, protecting legal rights, preventing transmission, and outreaching support behaviors. At the intrapersonal level, a combatant identity was constructed in the online community. The combatant identity was significantly associated with high self-efficacy, positive emotions, and outreaching support behaviors, but it was not significantly associated with environmental barriers. The constructed online combatant identity appeared to be support-focused instead of politically oriented.

Major depression and generalized anxiety disorder among human T-lymphotropic virus types I- and II-infected former blood donors

BACKGROUND

Other studies have reported high rates of depression and anxiety among human T-lymphotropic virus Type I (HTLV-I)-infected subjects and have even suggested that HTLV-I causes psychiatric disease.

STUDY DESIGN AND METHODS

We interviewed HTLV-I, HTLV-II, and demographically similar HTLV-seronegative blood donors with the Mini-International Neuropsychiatric Interview. Prevalences of major depression and generalized anxiety disorder in each group were calculated and compared to published US population data. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) controlling for educational achievement, alcohol intake, and self-reported health status were calculated with multivariate logistic regression.

RESULTS

Major depression was diagnosed in five (5.4%) of 93 HTLV-I-positive subjects (aOR, 2.19; 95% CI, 0.63-7.55) and 17 (6.6%) of 256 HTLV-II-positive subjects (aOR, 1.61; 95% CI, 0.66-3.927), compared to 12 (2.1%) of 585 HTLV-seronegative blood donors. The prevalence of major depression among infected subjects was comparable to the 6.7% prevalence in the US general population. Generalized anxiety disorder was diagnosed in five (5.4%) HTLV-I-positive subjects (OR, 2.32; 95% CI, 0.74-7.26) and 12 (4.7%) HTLV-II-positive subjects (OR, 1.65; 95% CI, 0.68-4.01), compared to 15 (2.6%) seronegative subjects and 3.1% in the US general population.

CONCLUSION

Major depression and generalized anxiety disorder were not significantly more prevalent among HTLV-I- and HTLV-II-infected former blood donors after controlling for health status and other confounding variables. HTLV-seronegative blood donors had lower prevalences of these conditions than the US population, probably due to a "healthy blood donor effect."

Complexity and uncertainty of living with an invisible virus of hepatitis B in Korea

The objective of this study was to explore infected Koreans' perceptions, knowledge, and experiences of living with a hepatitis B virus (HBV)-positive diagnosis. The qualitative, descriptive study with a purposive sampling method was utilized. Participants were recruited from hepatology outpatient clinics at an urban Korean university hospital. The findings of this study illustrate the complexity and uncertainty of living with an invisible virus once that one's HBV positive status is known. The themes highlight misunderstanding, confusion, uncertainty, and various perceptions of health management with which the patients have been living. Education of both the general public and people with HBV infection is necessary to reduce HBV infection by preventing transmission of the virus and protecting the livers of infected patients from further damage.

Hepatitis B screening compliance and non-compliance among Chinese, Koreans, Vietnamese and Cambodians

Objective:

The purpose of this community-based study was to determine factors associated with hepatitis B virus (HBV) screening compliance and non-compliance among Chinese, Korean, Vietnamese and Cambodian adults with varying levels of English language proficiency.

Methods:

A cross-sectional design was used consisting of a sample of 1,603 Asian adult men and women.

Results:

Overall, 71.4% of the sample reported having never been screened and 28.6% reported being screened for HBV. Demographic, acculturation, and barrier factors were differentially associated with screening rates among the subgroups. Demographic factors associated with never-screened were: lower education, younger age, being male, and no insurance for Chinese; lower education, lower income and no insurance for Cambodians; younger age and unmarried for Koreans; and no health insurance for Vietnamese; Acculturation factors associated with never-screened were: not speaking English for Chinese; not speaking English, not reading newspapers in English, and watching TV in one’s native language for Cambodians; not speaking English for Koreans; while no significant factors were found for Vietnamese. All barriers were associated with never-screened for Cambodians and Chinese. Those who lacked knowledge about HBV and had language and transportation barrier were more likely to be never-screened for Koreans. There were no significant relationships between the barriers and the screening status for Vietnamese.

Conclusions:

High incidence of HBV and liver cancer in Asian Americans mandates a more vigorous and more culturally and linguistically appropriate educational effort to increase screening and vaccination for HBV in these underserved and mostly uninsured populations.

Model of life expectancy of chronic hepatitis B carriers in an endemic region

Background

Chronic infection with hepatitis B (HBV) is a known risk factor for increased mortality from hepatocellular carcinoma (HCC) and chronic liver disease (CLD). However, the specific effects of chronic HBV infection on life expectancy have not been adequately studied. Taiwan is endemic for HBV infection, and thus provides sufficient information for such estimates.

Methods

Population mortality statistics, combined with data on the contribution of HBV to HCC and CLD deaths, were used to model carrier mortality by sex and e antigen status. An abridged life table was used to calculate carrier life expectancy.

Results

Among both males and females, those who are e antigen-positive are more likely to die from HCC than from CLD. When e antigen status remains positive, absolute liver mortality rates climb significantly after age 40 years. CLD is a proportionally higher threat for e antigen-negative females than for other subgroups. Males have higher liver-related mortality at all ages. A small decrease in life expectancy, from 82.0 to 80.1 years, was found for female noncarriers versus female carriers; a larger discrepancy was observed for males—from 76.2 to 71.8 years. In comparison to noncarriers, the lifetime relative risk of mortality is 1.35 for male carriers and 1.16 for female carriers.

Conclusions

These results indicate that chronic HBV infection results in significant liver-related mortality; however, carriers retain a satisfactory life expectancy.

Psychosocial stress and liver disease status

"Psychosocial stress" is an increasingly common concept in the challenging and highly-demanding modern society of today. Organic response to stress implicates two major components of the stress system, namely the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Stress is anamnestically reported by patients during the course of disease, usually accompanied by a decline in their overall health status. As the mechanisms involving glucocorticoids and catecholamines have been deciphered, and their actions on immune cell function deeper understood, it has become clear that stress has an impact on hepatic inflammatory response. An increasing number of articles have approached the link between psychosocial stress and the negative evolution of hepatic diseases. This article reviews a number of studies on both human populations and animal models performed in recent years, all linking stress, mainly of psychosocial nature, and the evolution of three important liver-related pathological entities: viral hepatitis, cirrhosis and hepatocellular carcinoma.

[Diagnosis of depression in Sub-Saharan immigrants]

OBJECTIVE

The migratory process, its social-demographic characteristics, and the lack of integration into the social and health networks of Sub-Saharan immigrants could favour an increase in mental health-related pathology. The objective is to find the prevalence of depression among this population and its risk factors.

DESIGN

Cross-sectional, descriptive survey.

SETTING

Community of Madrid, Spain.

PARTICIPANTS

Sub-Saharan immigrants over 18 years old who attended 2 "Health Care Programmes for immigrants in the Community of Madrid" between August 2003 and February 2004.

MEASUREMENTS

Semi-structured interviews (DSM-IV criteria) conducted by trained staff and the Beck Depression Inventory were used to diagnose depression.

RESULTS

Of 606 Sub-Saharan immigrants, 55.45% were men. Average age was 27 +/- 6.61. Depression diagnosis was 5.4% (95% CI, 3.78-7.56). There was greater risk of depression among those immigrants who had lived in Spain for over 2 years (13.1%), among those who had children (10.7%), and among those with certain health problems, such as muscle and skeletal trouble (18.9%), gastro-intestinal problems (18.8%), neurology problems (17.4%), dermatology problems (20.5%) and fatigue (70.6%). Six percent of immigrants with depression took pharmacological treatment.

CONCLUSIONS

The prevalence of depression among Sub-Saharan immigrants is similar to that of the native population. There is an increase as they stay longer in our country, probably due to their social and economic situation, which over time can act as a chronic stress factor. The other main fact is the lack of treatment of immigrants diagnosed with depression.

Symptomatology and health attitudes of chronic hepatitis B patients in the USA

This study was conducted to understand the symptomatology, attitudes, and behaviours of chronic hepatitis B (CHB) patients in the USA. CHB patients enrolled in this study were recruited through multiple methods, including newspaper advertisements. Interviews were conducted in multiple languages, and all participants had a history of CHB infection for at least 6 months. Patients with documented human immunodeficiency virus or hepatitis C virus coinfection were excluded from data analyses, resulting in a total study population of 258 respondents who completed interviews between April and June 2004. The majority of monoinfected patients were male (57%) and non-Asian (92%, including 52% Caucasian, 32% African American and others). Length of diagnosis was 5.8 years for all participants (9.1-year Asian and 5.1-year non-Asian). Ninety-five per cent of CHB patients reported symptoms of differing severity in the 12 months prior to the survey. The most common symptoms included fatigue/loss of energy (90%) and loss of appetite (79%). Non-Asian patients described greater symptomatology, and were more likely than Asians to consider CHB an overriding concern in their daily activities. Patients were treated either currently or previously with interferon (IFN) described greater symptomatology than those treated without IFN. Survey results indicate that CHB patients may have greater symptomatology than recognized. Disease perceptions and treatment attitudes differ between Asian and non-Asian ethnic groups, with the former appearing to be more accepting and less concerned about the disease. Additional research about CHB symptomatology and health attitudes by ethnicity is needed to ensure that individuals with CHB are educated on the potential health risks and the availability of current treatment options.

Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C

OBJECTIVE

The primary aim of our study was to determine the prevalence of psychiatric morbidity in a cohort of consecutive chronic hepatitis patients not receiving antiviral therapy. The secondary aim of our study was to determine if psychiatric morbidity, type of hepatitis, and the level of depression correlated with health-related quality of life (HRQL).

METHODS

The study was conducted in collaboration with Hepatology and Infectious Disease Clinics at three-major university hospitals. One hundred seven patients who met the criteria for being diagnosed with either chronic hepatitis B or C, had non-cirrhotic compensated liver disease, had not received antiviral treatment in the preceding 6 months, and had no accompanying physical illness were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Short Form--36 for measuring HRQL, and semi-structured interviews for assessing psychosocial variables were used. Sixty-seven healthy adults formed the control group.

RESULTS

43.9% of the patients had hepatitis B, 56.1% hepatitis C. A psychiatric diagnosis was made in 48.6%, of which 15% was depression. No significant difference was found in the rate of psychiatric diagnosis between hepatitis B and hepatitis C patients. Hepatitis B and C patients were found to vary significantly (p < 0.001) from the control group on all subcategories of quality of life criteria. Psychiatric morbidity (mainly depression) was the major variable on lowering HRQL (p = 0.000).

CONCLUSIONS

Chronic hepatitis B and C patients presented a high rate of psychiatric disorder. HRQL was significantly decreased in patients with psychiatric morbidity.

Does stress exacerbate liver diseases?

Although anecdotal comments on detrimental effects of psychosocial stress on liver diseases can be found even in the early literature, only recently has scientific evidence been reported. The present article reviewed such evidence to demonstrate how stress exacerbates liver diseases. A search of the literature from the last two decades was performed using MEDLINE by pairing 'psychological stress' with 'liver' or 'hepatitis.' Additional research was conducted by screening the bibliographies of articles retrieved in the MEDLINE search. The search results showed that the principal effectors of the activated hypothalamic-pituitary-adrenal (HPA) axis, glucocorticoids, can exert a facilitative effect on the hepatic inflammatory response and even increase the risk of developing hepatocellular carcinoma. For certain liver diseases, defective HPA axis activation, which probably contributed to the exacerbation of the liver disease, has been reported. The efferent sympathetic/adrenomedullary system mainly contributes to the stress-induced exacerbation of liver diseases via its neurotransmitters, the catecholamines. In contrast, the efferent parasympathetic nervous system elicits an inhibitory effect on the development of hepatic inflammation. In conclusion, the pathophysiological interaction between stress and the liver appears to be regulated by the complex, dynamic networks of both the endocrine and autonomic nervous systems, which implies a further need for basic research into the involved mechanisms and for clinical evidence to apply psychosocial support to patients with chronic liver diseases.

High risk of schizophrenia and other mental disorders associated with chlamydial infections: hypothesis to combine drug treatment and adoptive immunotherapy

Many microbial factors have been implicated as pathogenic factors in mental disorders. Occurrence of such microbial factors also in the mentally unaffected population raised skepticism against such findings, although each microbial factor may cause mental problems only in some individuals, depending on the individual's immunogenetic disposition. Skepticism against the role of infection in schizophrenia was also fostered by the low impact of antiinfections treatment on the course of disease progression in schizophrenia. We discovered previously that neurotrophins like neurotrophin3 (NT-3) and brain-derived neurotrophic factor (BDNF), involved in processes of neuroplasticity, are also secreted by immune cells, but only by subpopulations of immune cells. Therefore, infection of the immune cell subpopulation, specialized in secreting BDNF, or of another subpopulation, specialized in secreting NT-3, could distort communication of immune cells with the central nervous system (CNS). Chlamydiaceae could cause disbalancement of immune cell sub-populations and, in some individuals with a vulnerable disposition, symptoms of mental illness. Based on previous observations of persisting IgA titers in some patients with mental illness we hypothesize that the intracellular parasites Chlamydiaceae are main pathogenic factors in schizophrenia. We hypothesize furthermore that antiinfectious treatment has to be accompanied by adoptive immunotherapy because antibiotics alone will not restore the balance of immune subpopulations. Our hypothesis is supported by examination of patients with schizophrenia and other mental disorders. Using nested PCR we found a significant prevalence of the intracellular parasites Chlamydophila psittaci, C. pneumoniae and Chlamydia trachomatis (9/18, 50%), as compared to controls (8/115, 6.97%) (chi(2)=25.86, Fisher's exact p two-tailed=5x10(-5)). Treatment with in vitro-activated immune cells together with antibiotic modalities showed sustained mental improvements in patients that did not depend on treatment with antipsychotic drugs. Future controlled studies including sham treatment of patients have to be carried out to prove our hypotheses.

Psychiatric Disorders and Functioning in Hepatitis B Virus Carriers

The authors compared asymptomatic hepatitis B virus carriers and healthy subjects in terms of their psychological state. Participants (43 asymptomatic hepatitis B virus carriers and 43 healthy comparison subjects) completed self-report questionnaires. Psychiatric disorders and psychosocial functioning were evaluated with structured clinical interviews and the Global Assessment of Functioning scale. Hepatitis B virus carriers were more likely to have psychiatric disorders than comparison subjects (30.2% vs. 11.6%). Also, carriers had significantly higher depression and anxiety scores and lower Global Assessment of Functioning scores than did comparison subjects. Worries about contamination and illnesses related to hepatitis B infection were associated with the presence of psychiatric disorder. The results suggest that asymptomatic hepatitis B virus carriers need emotional support.

Psychological stress impairs hepatic blood flow via central CRF receptors in mice

Some previous works have further expanded the 'Brain-Gut axis', that is a bi-directional interaction between the gut and brain function, into a relationship of the brain with the liver. However, all the details of such brain-liver relationship were not fully understood because appropriate animal models had not been established yet. Here we developed a novel animal model, in which hepatic blood flow of conscious mice could be measured in real-time. In addition, using this model, we also demonstrated that exposure to psychological stress considerably reduced hepatic blood flow via central CRF receptors. Thus, this new model is considered to be a useful and promising tool for elucidating the precise effects of emotional factors on liver function.

Psychosocial Stress, Personality, and the Severity of Chronic Hepatitis C

This cross-sectional study examined the association between the severity of chronic hepatitis C and the type 1 personality, which has been shown by Grossarth-Maticek to be strongly related to the incidence of cancer and mortality. Sixty-nine patients with chronic hepatitis C completed the Stress Inventory, a self-report questionnaire to measure psychosocial stress and personality, and were classified into three groups according to hepatitis severity: group A, chronic hepatitis C with a normal serum alanine aminotransferase level; group B, chronic hepatitis C with an elevated alanine aminotransferase level; and group C, liver cirrhosis. Each of four scales related to the type 1 personality--low sense of control, object dependence of loss, unfulfilled need for acceptance, and altruism--was significantly and positively associated with hepatitis severity. The type 1 score, calculated as the average of these scales, was also strongly related to hepatitis severity (p<0.0001), and adjustment for age, sex, education level, smoking, drinking, and duration brought no attenuation into the association. Chronic psychosocial stress relevant to the type 1 personality may also influence the course of chronic hepatitis C.

Side effects of therapy of hepatitis C and their management

Interferon and ribavirin combination therapy for chronic hepatitis C produces a number of well-described side effects that are dominated by fatigue, influenza-like symptoms, hematologic abnormalities, and neuropsychiatric symptoms. Combination therapy with pegylated interferons (peginterferon alfa-2a and alfa-2b) yields an adverse event profile similar to standard interferon, although the frequency of certain adverse events may vary by preparation. Premature withdrawal from therapy due to adverse events was required in 10% to 14% of participants in registration trials of these agents. Most adverse events were safely and effectively managed by dose reduction using predetermined criteria. The most common indications for dose reduction were hematologic abnormalities, such as anemia and neutropenia, with the latter more frequent in peginterferon treatment arms. Recent data suggest that maintaining adherence to a prescribed treatment regimen can enhance antiviral response. Strategies to maximize adherence are being developed and, in the future, may include early identification of and therapy for depression and the selective use of hematopoietic growth factors to ameliorate hematologic abnormalities.

Side effects of therapy of hepatitis C and their management

Interferon and ribavirin combination therapy for chronic hepatitis C produces a number of well-described side effects that are dominated by fatigue, influenza-like symptoms, hematologic abnormalities, and neuropsychiatric symptoms. Combination therapy with pegylated interferons (peginterferon alfa-2a and alfa-2b) yields an adverse event profile similar to standard interferon, although the frequency of certain adverse events may vary by preparation. Premature withdrawal from therapy due to adverse events was required in 10% to 14% of participants in registration trials of these agents. Most adverse events were safely and effectively managed by dose reduction using predetermined criteria. The most common indications for dose reduction were hematologic abnormalities, such as anemia and neutropenia, with the latter more frequent in peginterferon treatment arms. Recent data suggest that maintaining adherence to a prescribed treatment regimen can enhance antiviral response. Strategies to maximize adherence are being developed and, in the future, may include early identification of and therapy for depression and the selective use of hematopoietic growth factors to ameliorate hematologic abnormalities.