Objective To prospectively evaluate for changes in objective cognitive performance (attention, memory, and executive function) and psychiatric symptom severity (depression, anxiety, fatigue, and pain) in patients before, during and after interferon-alpha based therapy (IFN) for chronic hepatitis C virus infection (HCV). Methods 33 HCV+ adults were evaluated two months before IFN initiation (baseline), three months into IFN, and six months following IFN termination (IFN+ Group). 31 HCV+ adults who did not undergo IFN therapy were evaluated at baseline and six months later (IFN− Group). At each evaluation, participants completed the Neuropsychological Assessment Battery (NAB) Attention, Memory and Executive Functions Modules, the Beck Depression Inventory, Second Edition (BDI), Generalized Anxiety Disorder Inventory (GADI), Fatigue Severity Scale (FSS), and Brief Pain Inventory (BPI). Results Compared with the IFN−Group, the IFN+ Group experienced significantly (p < 0.050) increased symptoms of depression, anxiety, fatigue and pain during IFN therapy relative to baseline. In the IFN+ Group, psychiatric symptoms generally returned to baseline levels following IFN termination. Sustained viral response was associated with significantly lower depression and fatigue. No significant changes in cognitive performance were observed. Conclusions During IFN, patients with HCV evidence significantly increased psychiatric symptoms, including symptoms of depression, anxiety, fatigue and pain. These psychiatric symptoms are generally short-term and remit following IFN termination, with increased benefit if viral clearance is achieved. However, IFN is not associated with significant declines in objective cognitive performance during or following IFN.
Delirium is a complex and multifaceted acute brain syndrome that occurs commonly in both general medical and intensive care unit ( ICU ) patients, with prevalence rates of up to 80% reported. Delirium is associated with a number of adverse outcomes including prolonged hospitalization, increased costs, higher mortality, and cognitive impairment. The pathophysiology underlying delirium remains unclear; however, research has shown that neurotransmitters, amino acids, inflammation, and impaired metabolism may be involved. Risk factors associated with delirium have implications for patient care and should be carefully evaluated. There are a number of scales that are reliable and valid measures for assessing incidence and severity of delirium. Multicomponent interventions to treat delirium are effective and should be implemented. Future studies should evaluate specific interventions, including pharmacological treatment, with the intent to prevent and treat delirium.
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