Transtornos psiquiátricos e hepatite C crônica: avaliação de pacientes atendidos em centro de referência para hepatites virais em Minas Gerais

Abstract

Background and objectives: In addition to hepatic-related sequelae, chronic infection with hepatitis C virus (HCV) is associated with numerous extrahepatic manifestations. Several studies have shown an increased prevalence of psychiatric disorders in patients with chronic hepatitis C (CHC). However, the interrelationship between the hepatitis C (HCV) and the psychiatric disorders is still not completely clarified and it may be more multifaceted than suspected. Our aims were: to identify the frequency of psychiatric disorders in patients with CHC; to assess the factors associated with psychiatric disorders; to evaluate the relationship of these disorders with liver cirrhosis. Methods: Patients with CHC underwent psychiatric evaluation and answered to questionnaires: MINI-Plus (5.0) and CAGE. Demographic and lifestyle data were obtained and laboratorial, virological and clinical evaluation was performed. Univariate and multivariate analyses were performed to determine independent variables associated with each type of psychiatric disorders and cirrhosis. Results: N=151, seventy-six (50.3%) patients with CHC had at least one current psychiatric diagnosis. The baseline characteristics of these individuals were: 56.6%, female; 56.6%, educational level nine years; 46.1%, total household income between one and three minimum wages; 22.4%, diabetes mellitus (DM); 32.9%, hypertension; 82,9%, chronic hepatitis and 17,1%, cirrhosis. Patients with CHC and current psychiatric disorder were younger than those without these disorders (p=0.03). Mood disorders (33.1%), alcohol abuse/dependence (30.4%), non-alcohol drug abuse/dependence (23.8%) and anxiety disorders (11.2%) were the most prevalent psychiatric disorders observed. Alcohol abuse (p<0.0001) and illicit drugs abuse (p=0.005) were more frequent in men than in women (58.6% vs. 11.1%) and (34.3% vs. 14.8%), respectively. Anxiety disorder was associated with marital status (divorced/widowed) (OR=2.06, 95%CI= 1.16-3.68, p=0.02) and age <55yrs (OR=0.62, 95%CI=0.41-0.94, p=0.009). Mood disorders was associated with low total household income (OR=0.60, CI95%=0.41-0.88, p=0.02). Alcohol abuse/dependence was associated with male sex (OR=9.56, 95%CI=3.32-27.56, p<0.0001) and non-alcohol drug abuse/dependence (OR=9.17, 95%CI=2.75-30.61, p<0.0001). Non-alcohol drug abuse/dependence was associated with illicit drug use (OR=8.02, 95% CI=2.00-32.30, p<0.003) and alcohol abuse/dependence (OR=12.09, 95%CI=3.30-44.41, p<0.0001). Cirrhosis was associated with alcohol abuse/dependence (OR=2.57, 95%CI=1.03-6.43, p<0.04), DM (OR=3.07, 95%CI=1.17-8.03, p<0.02) and elevated aspartate aminotransferase (OR=1.01, 95%CI=1.01-1.02, p=0.006). Conclusions: In this study, we observed high frequency of psychiatric disorders. These disorders can influence the course and treatment of CHC, therefore efforts should be made to ensure that the screening of psychiatric disorders takes place in the course of routine clinical care. Considering the hepatitis C as a systemic disease, integrated clinical/psychiatric/psychological care must be pursued in the management of individuals chronically infected with HCV.