Depression and fatigue must be properly investigated and managed in HCV patients in order to improve HRQL. WHOQOL-BREF proved to be a useful instrument to assess HRQL in HCV patients.
564www.scielo.br/rsbmt I www.rsbmt.org.br Revista da Sociedade Brasileira de Medicina Tropical 47(5):564-572, Sep-Oct, 2014http://dx.doi. org/10.1590/0037-8682-0147-2014 Major Article ABSTRACT Introduction: The prevalence of sexual dysfunction (SD) and dissatisfaction with sexual life (DSL) in patients with chronic hepatitis C virus infection (CHC) was jointly investigated via a thorough psychopathological analysis, which included dimensions such as fatigue, impulsiveness, psychiatric comorbidity, health-related quality of life (HRQL) and sociodemographic and clinical characteristics. Methods: Male and female CHC patients from an outpatient referral center were assessed using the Brief Fatigue Inventory, the Barrat Impulsiveness Scale, the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale (HAM-A), and the World Health Organization Quality of Life Scale-Brief Version (WHOQOL-BREF). Structured psychiatric interviews were performed according to the Mini-International Neuropsychiatric Interview. SD was assessed based on specifi c items in the BDI (item 21) and the HAM-A (item 12). DSL was assessed based on a specifi c question in the WHOQOL-BREF (item 21). Multivariate analysis was performed according to an ordinal linear regression model in which SD and DSL were considered as outcome variables. Results: SD was reported by 60 (57.1%) of the patients according to the results of the BDI and by 54 (51.4%) of the patients according to the results of the HAM-A. SD was associated with older age, female gender, viral genotype 2 or 3, interferon-α use, impulsiveness, depressive symptoms, antidepressant and benzodiazepine use, and lower HRQL. DSL was reported by 34 (32.4%) of the patients and was associated with depressive symptoms, anxiety symptoms, antidepressant use, and lower HRQL. Conclusions: The prevalence of SD and DSL in CHC patients was high and was associated with factors, such as depressive symptoms and antidepressant use. Screening and managing these conditions represent signifi cant steps toward improving medical assistance and the HRQL of CHC patients.
rESUMoA vitamina B12, ou cianocobalamina, desempenha importantes funções metabólicas e neurotróficas. Sua deficiência está associada a distúrbios hematológicos, neurológicos e psiquiátricos. É relatado o caso de uma paciente com depressão refratária ao tratamento com antidepressivos que melhorou somente após a detecção e o tratamento da deficiência de vitamina B12. Esse relato ilustra a importância de o psiquiatra considerar causas secundárias de depressão em casos refratários. . É interessante notar que, segundo alguns trabalhos, níveis mais elevados de vitamina B12 estiveram associados a melhores resultados em pacientes com depressão maior tratados com antidepressivos 2 . Neste relato, descreveu-se o caso de uma paciente com transtorno depressivo refratário ao tratamento psicofarmacológico tradicional, que evoluiu com remissão dos sintomas depressivos logo após a correção de deficiência de vitamina B12. rElato DE CaSoTrata-se de paciente de 42 anos, do sexo feminino, solteira, sem filhos, católica, com primeiro grau completo, desempregada há cerca de seis meses, período em que interrompeu o trabalho que desempenhava como auxiliar de serviços gerais a fim de cuidar do pai que estava doente. A paciente solicitou ao seu clínico-geral um encaminhamento para acompanhamento psiquiátrico, pois persistia com sintomas depressivos a despeito do uso de amitriptilina na dose de 50 mg/dia,
Objective: Major depression (MD) is a condition associated with both hepatitis C virus (HCV) infection and pegylated interferon (IFN)-α treatment. IFN induces a depressive syndrome that is associated with an inflammatory profile. We aimed to investigate whether there is any specific alteration in plasma biomarkers associated with MD. Methods: HCV-monoinfected patients, with and without IFN treatment, were followed up for 18 months and went through structured psychiatric evaluation. We assessed plasma levels of brain-derived neurotrophic factor, tumor necrosis factor (TNF) and its soluble type 1 and type 2 receptors (sTNFR1 and sTNFR2, respectively), and adipokines (adiponectin, leptin and resistin) using ELISA. Results: Among the 50 patients included in the study, 14 were treated with IFN during the follow-up. Being older, not married, presenting higher body mass index, higher liver inflammatory activity, lower baseline adiponectin levels and use of IFN were associated with MD development. Higher levels of sTNFR1 during IFN treatment were associated with sustained virological response. The lack of a control group without HCV infection did not allow any assumption of a biomarker change exclusively due to the infection itself. Conclusion: Adiponectin may be a resilience biomarker for MD in HCV-infected patients.
Chronic infection with the hepatitis C virus (HCV) is a worldwide health problem. 1 The mainstay of treatment includes the use of pegylated interferon-a (peginterferon alfa). Interferon (IFN) therapy is frequently associated with psychiatric adverse events, such as depressive disorders, which occur in approximately 30% of patients. 2 Selective serotonin reuptake inhibitors (SSRI) are the first-line treatment of choice for IFN-associated depression. 3 However, nonresponse or poor response is common. 4 Antidepressants with broader mechanisms of action, such as the serotonin and norepinephrine reuptake inhibitors (SNRI), could theoretically increase remission rates. One such agent, desvenlafaxine, presents a favorable pharmacokinetic profile and its hepatic metabolism consists essentially of glucuronidation. 5 Herein, we report two patients with hepatitis C who developed depression while receiving standard doses of IFN and were treated with desvenlafaxine. There is no previous report of desvenlafaxine use for this specific indication.A 45-year-old man with genotype 1 HCV infection, elevated alanine aminotransferase (337 IU/L), and a METAVIR score of A2F3 (denoting moderate inflammatory activity and advanced fibrosis without cirrhosis) developed depressive symptoms, with Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D) scores of 15 and 10 respectively. He was prescribed citalopram at a dosage scaled up to 40 mg/ day. Four weeks later, IFN was initiated. After 8 weeks of IFN treatment (week 12 of citalopram), depression worsened, as demonstrated by a severely depressed mood, apathy, hopelessness, suicidal ideation, fatigue, and muscle pain. His BDI and HAM-D scores were 45 and 21 respectively. Citalopram was switched to desvenlafaxine and the dose was titrated up to 100 mg/day. A clinically significant reduction of depressive symptoms was achieved after 8 weeks (week 16 of IFN treatment), with a BDI score of 10 and HAM-D of eight.A 49-year-old man with genotype 1 HCV infection, elevated alanine aminotransferase (123 IU/L), and METAVIR score of A2F2 (denoting moderate inflammatory activity and moderate fibrosis) presented with a complaint of emotional instability, insomnia, loss of appetite, fatigue, sexual dysfunction, muscle and joint pain, and irritability after 16 weeks of IFN treatment. By the 25th week of antiviral treatment, he had developed full-blown major depression. The BDI score increased from four at baseline to 26 at this time point, and the HAM-D score increased from three to 23.Desvenlafaxine was started, with the dose titrated up to 100 mg/day. The patient reported partial improvement of insomnia and irritability, but did not achieve remission of symptoms even after 8 weeks of desvenlafaxine (week 33 of IFN treatment). His BDI and HAM-D scores decreased during this period, from 26 to 19 points and 23 to 14 points respectively. Full remission of depressive symptoms occurred only after the end of IFN treatment.Both patients tolerated desvenlafaxine well, with no increase in l...
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