An Overview of Psychiatric Issues in Liver Disease for the Consultation–Liaison Psychiatrist

Crone, Catherine; Gabriel, Geoffrey M.; DiMartini, Andrea F.

doi:10.1176/appi.psy.47.3.188

Cited by 32 publications

(28 citation statements)

References 174 publications

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“…33,79,80 Dosage adjustment is recommended for quetiapine, olanzapine, and risperidone in patients with hepatic insufficiency. 81 Pharmacological treatment studies for sleep disorders in CHC patients are limited. Spahr and colleagues 82 examined the off-label use of hydroxyzine, a histamine H1 blocker, for the treatment of sleep difficulties in patients with chronic liver disease.…”

Section: Insomniamentioning

confidence: 99%

A Review of Sleep Disturbance in Hepatitis C

Sockalingam¹,

Alosaimi²,

Novák³

2010

Journal of Clinical Gastroenterology

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Sleep disturbances occur in up to 60% of patients with chronic hepatitis C (CHC) and is often interrelated with comorbid psychiatric disorders. Moreover, neuropsychiatric complications of interferon-alpha during CHC treatment can manifest as sleep problems. Newly diagnosed sleep disturbance occurs in up to 60% and 30% of untreated CHC patients and patients undergoing interferon-alpha therapy, respectively. However, the presentation of insomnia in patients with CHC is influenced by significant psychiatric comorbidity, such as depression, and medical conditions, such as anemia and hypothyroidism. Therefore, prompt recognition using screening tools and exclusion of comorbid conditions contributing sleep pathology can enhance treatment outcomes. Owing to the paucity of studies, treatment recommendations for sleep disorders in CHC patients are derived from recommendations from general sleep disorder treatment guidelines. Further research is needed to elucidate the efficacy of pharmacological and nonpharmacological treatments of sleep disorders in CHC patients.

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Section: Insomniamentioning

confidence: 99%

A Review of Sleep Disturbance in Hepatitis C

Sockalingam¹,

Alosaimi²,

Novák³

2010

Journal of Clinical Gastroenterology

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“…If hepatic encephalopathy is suspected as the cause of mental status changes, it remains necessary to exclude other potential causes of delirium, including infections, metabolic disturbances, intracranial hemorrhage (as liver disease-related clotting deficiencies may increase bleeding risk), seizure, and stroke (22,27). Physical findings associated with hepatic encephalopathy may be present, but they may only be markers of decompensated liver disease, not necessarily hepatic encephalopathy.…”

Section: Differential Diagnosis Of Hepatic Encephalopathymentioning

confidence: 99%

“…Brain imaging (CT or MRI) can rule out intracranial pathology, such as stroke, tumor, and hemorrhage. EEG may show generalized slowing and triphasic waves in overt hepatic encephalopathy and a slowed mean dominant frequency in minimal hepatic encephalopathy (23), but these abnormalities are seen in other encephalopathies (27). Still, EEG may be useful in Am J Psychiatry 171:1, January 2014 ajp.psychiatryonline.org differentiating substance-induced mental status changes, seizure, and primary psychiatric illness (25).…”

Section: Differential Diagnosis Of Hepatic Encephalopathymentioning

confidence: 99%

“…For hepatically metabolized medications, impaired hepatic functioning leads to delays in reaching steady-state concentrations and prolonged elimination half-lives, necessitating slower titrations and dose reductions of many commonly used psychiatric medications (27). In cirrhosis, glucuronidation pathways (phase II metabolism) may be relatively spared relative to oxidative pathways (phase I), making medications that rely primarily on phase II pathways (e.g., some benzodiazepines, such as oxazepam, lorazepam, temazepam) preferable (27).…”

Section: The Psychiatrist's Rolementioning

confidence: 99%

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Schizophrenia Complicated by Chronic Hepatitis C Virus and Hepatic Encephalopathy

Viron¹,

Stern²,

Keshavan³

2014

AJP

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“…Comprehensive information on individual psychotropic drugs can be found in Crone et al (2006). Key points about neuropsychiatric symptoms and their management are listed in Box 5.…”

Section: Managing Adverse Effects Of Interferonmentioning

confidence: 99%

Hepatitis C: a patient's journey from a psychiatrist's perspective

Badrakalimuthu¹,

Rumball²,

Chawla³

2011

Adv. psychiatr. treat

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SummaryThere is an increasing prevalence of hepatitis C, particularly among intravenous drug users. Estimates of infection with the hepatitis C virus (HCV) in patients with severe mental illness in the USA have ranged from 8.5% to 19.6%. Alcohol use and misuse is the single biggest contributory factor to the development of fatal liver disease in people with hepatitis C. Neuropsychiatric symptoms are present in HCV infection, independent of any treatment. Despite such alarming observations, the success rate of antiviral treatment in chronic hepatitis C has improved considerably in recent years. This article explores psychiatrists' involvement in advocating for treatment inclusion, assessing patients' capacity to make treatment-related decisions and supporting the medical team in managing the complex journey a patient undertakes from being at high risk to receiving treatment for neuropsychiatric symptoms.

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An Overview of Psychiatric Issues in Liver Disease for the Consultation–Liaison Psychiatrist

Cited by 32 publications

References 174 publications

A Review of Sleep Disturbance in Hepatitis C

A Review of Sleep Disturbance in Hepatitis C

Schizophrenia Complicated by Chronic Hepatitis C Virus and Hepatic Encephalopathy

Hepatitis C: a patient's journey from a psychiatrist's perspective

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