The hepatitis C virus (HCV) epidemic in Egypt is unique in the world and well documented in the international medical scientific literature, (Saleh et al., 2008).
The prevalence of psychiatric disorder including substance abuse and mood disorder are greater in patients with HCV than in general population. (Yates & Gleason, 1998). Psychiatric disorder or drug addiction are often regarded as contraindication against the use of interferon alpha in patient with chronic hepatitis, (Martin Schaefer et al., 2003).
This study aims at determination of the incidence of mental disorder using pegylated interferon plus ribavirin treatment in hepatitis C virus-infected patients, evaluation of the effect of psychological illness on quality of life, studying the possible psychiatric complications of chronic hepatitis C infection and studying the possible relationship between psychiatric complications and clinical , hepatic and serological finding of the patients.
This study was conducted upon 90 patients. The patients were randomly selected from hepatic viruses treatment Centre in Benha fever hospital and National Committee for Control of Viral Hepatitis in the period between October 2010 June June 2011.
They were subdivided into 3 groups:
• Group 1: It included thirty patients with chronic hepatitis C received interferon therapy [HCV treatment].
• Group 2: It included thirty patients with chronic hepatitis C who are not received interferon therapy will serve as control group.
• Group 3: It included thirty patients with other chronic liver disease [hepatitis B] were included as a control group.
All the patients were subjected to the following:
*Semi-structure interview
All presenting cases were asked for an interview then written informed consent
I. General medical examination:
II. Thorough history taking
Current episode of psychiatric illness or history of disorder, history of psychiatric hospitalization, history of substance abuse or dependence and family history of affective disorder or suicide attempt or other psychiatric disorders.
III. Psychometric Assessment:
A -psychiatric evaluation according to ICD-10 symptom checklist
B- quality of life( PCASEE scale).
C- Hostility and direction of hostility questionnaire.
IV. Laboratory investigations:
A- Liver functions profile: (has been done for the patients and control group):
B- Hepatitis Markers:
V-Liver biopsy:
VI. Abdominal ultrasonography [liver and spleen].
The results of this study showed that :
The prevalence of HCV infection was highest among age group 30-40 years, the Married people were more infected, from rural area and had bilharziasis, with unknown source of infection, may be due to living in a house with an infected family member, with history of frequent visits to dentist , had received blood transfusion and with history of operation which reflect the hygiene for invasive medical, dental, or paramedical procedures . Most of infected patients without pre-existing psychiatric disturbances, without family history of psychiatric disorder.
It was found that the most common Pre-existing psychiatric disorder among HCV patients receive HCV treatment was generalized anxiety disorder upon diagnosis or before starting any therapy ,may be related to the patient awareness of the diagnosis and prognosis to side effects induced by interferon (IFN)-alpha treatment, tensions about transmitting infection to others and the possibility of future complications, and death, and increased after treatment by 4 weeks as patients developed mild depression , other mixed anxiety and depression and moderate depression, followed by mixed anxiety and depression and panic disorder.
At 12th week, in order of frequency, mixed anxiety and depression, moderate depression and severe depression without psychotic feature, at 24 weeks, Increase mild depression and decrease severe depression without psychotic feature may be due to change in the dose of ribavirine at this time.
Patients excluded from HCV therapy were due to addiction, depression and suicide, increase body weight more than 100 kg , high degree of fibrosis F4, PCR +ve, improper lab result and pregnancy, those patients had mild depression and mixed anxiety and depression.
Panic disorder were reported in patients with CHC who received treatment, and in patients with CHB, suggest that anxiety disorders are not a specific consequence of CHC, but rather reflect the stress associated with the awareness of a chronic progressive disease, also HBV patients had mild depression and mixed anxiety and depression, which was not related to the severity of liver disease, but severe depression without psychotic symptoms related to liver enzyme and portal tract thickening and enlarged spleen.
Regarding hostility, we found feelings of anger and hostility were greater in patients with chronic HCV infection, after 12 and 24 weeks of interferone treatment, patient experienced increased total hostility degree including more criticism of others 24 week after starting therapy and had extrinsic aggression which cause relational problems in married patients and vocational problems, which related to the dose of ribavirine.
Comparing between HCV patients who received treatment and who excluded from treatment with HBV patients we found increase total hostility degree including criticism of others, then self criticism and more intrinsic hostility among HCV patients with delayed treatment and extrinsic hostility among HBV. Self criticism was related to moderate depression at patients who excluded from therapy, and panic disorder related to paranoid hostility, guilt feeling and total hostility degree, other mixed anxiety depression related to acting out hostility and criticism of others, and severe depression without psychotic symptoms related to guilt feeling among HBV patients, this results not related to the severity of liver disease. On other hand paranoid hostility & acting out hostility of patients who excluded from therapy was increase with increased ALT level and with increase the stage of fibrosis and grade of inflammation of liver.
Commonly reduce quality of life among patients receiving peg-interferon/ ribavirin treatment at 12th week and 24th week after starting therapy, particularly those affecting physical symptom, Cognitive function, affective disorder and social problem, this finding is not correlated with INF dose and increase ribavirin dose accompanied with decrease social function.
Decrease in quality of life also in HCV patients excluded from treatment regarding cognitive function followed by physical symptoms and social problems and more economic problem in HBV groups.
There was correlation between: mixed anxiety and depression with cognitive dysfunction in our HCV patients before treatment, mixed anxiety and depression and somatoform disorder with physical symptoms & moderate depression with cognitive function in our HCV patients excluded from therapy. And moderate depression with physical symptoms, mild depression with cognitive function, social problems, ego disorder & total quality of life, mixed anxiety and depression with economic problems in our HBV patients.
Cognitive functions, social problems and total score of quality of life decrease with increased severity of liver disease among HCV patients excluded from treatment, decrease in social function, and quality of life with bright liver among HBV patients.
The cognition, social function and quality of life decrease with increase degree of fibrosis and inflammation among HCV patients excluded from treatment and increase degree of fibrosis and inflammation with decrease ego function among HCV patients before treatment.
HCV treatment induced weight loss at 12th week, and at 24th week may be due to loss of appetite and reduction in calorie intake. The weight loss is rapidly reversible upon discontinuation of therapy, fatigue are frequent complaints at 4th week may be due to anemia and depression and at 12th week, suicidal ideas and tension-type headache, marital and occupational problems were common, post-treatment disorder at 24th week sexual dysfunctions was reported. For some participants feelings of anger and loss of control linked to suicidal and even homicidal thoughts, that correlated with the severity of liver disease.
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