Psychiatry Research EG

Hepatitis C virus (HCV) infection is gaining increasing attention as a global health problem, with B3% of the world’s population affected [1,2]. It has been estimated that B130–170 million individuals worldwide are chronically infected with the HCV [3,4]. In the absence of treatment, 20% of these patients will develop liver cirrhosis and 1–4% will develop hepatocellular carcinoma [5,6]. Currently, chronic hepatitis C is the leading indication for liver transplantation [7]. Egypt reports the highest prevalence of HCV worldwide, with an average of 13.8% [8] and ranging from 6 to 40% [9]. HCV infection has become the leading risk factor for hepatocellular carcinoma in Egypt [10]. The major route of exposure to HCV appears to have been widespread parental antischistosomal treatment, with more than 35 million injections administered over a 20-year period (1960–1980) [9]. However, transmission continues despite termination of this program and the implementation of measures to reduce infection [11]. Nowadays, the optimal treatment for HCV infection consists of a combination of antiviral therapy with pegylated interferon (IFN)-a and ribavirin [12,13]. Treatments with IFN-a have the potential to alter the course of chronic hepatitis, prevent complications, and improve outcome [14–16]. However, IFN therapy may induce several side effects, with neuropsychiatric manifestations being the most common, ranging from 7 to 35% [17,18]. They include depression, anxiety, fatigue, mania, cognitive impairment, psychotic symptoms, craving and relapse into drug abuse, and suicidal thoughts or even suicidal attempts [19–21]. In many patients, psychiatric side effects of IFN therapy are the main reason for limited utility, adherence to the IFN therapy [22,23], and deterioration in social, occupational, and academic functioning [24]. Moreover, IFNinduced depression and other psychiatric syndromes may be correlated with a poor response as evidenced by diminished rates of viral clearance [25], and may compromise compliance by interruption of IFN therapy that may be life saving in patients with chronic HCV [26]. The exact mechanisms by which IFN induces depression and other psychiatric side effects still remain poorly understood [27]. Possible mechanisms include decreased concentrations of tryptophan and serotonin [28], neurotransmitter abnormalities [29], thyroid and adrenal dysfunction [30,31], and activation of the immune system [32]. The aims of this study were: (a) to study the incidence of psychiatric disorders after 12 weeks of treatment with IFN-a2b and ribavirin in a cohort of Egyptian patients with chronic C hepatitis. (b) To identify the factors associated with an increased risk for psychiatric disorders in those patients. (c) To determine the relation between the incidence of depression and response to antiviral therapy.