Psikiyatrik bakış açısıyla kronik hepatitler

Kronik hepatit B ve C virüs enfeksiyonlarının gidişi sırasında psikiyatrik belirtilere sık rastlanmaktadır. Alkol ve madde kullanım bozukluklarının sık görülen komorbiditesi nedeniyle kronik hepatitli hastaların sevk ve idareleri sırasında psikiyatristlerin aktif katılımı gerekli ve önemlidir. Konsültasyon-liyazon psikiyatristleri bu ekip çalışmasında önemli bir rol oynar. Günümüzde psikiyatrik bozukluğu olan kronik hepatitli hastaların tedavisiyle ilgili bir görüş birliğine henüz varılamamıştır. Güncel tedavi kılavuzlarında, antiviral tedaviye başlanmadan önce saptanan depresyon ve alkol kullanım bozukluklarının tedavide 6 aya varan gecikmelere yol açtığına işaret edilerek, kronik hepatit tedavisi öncesi kapsamlı bir psikososyal değerlendirme önerilmektedir. Kronik hepatitli bir hastada, eşlik eden psikiyatrik bozukluğun gözden kaçması ve tedavi edilmemesi, hastanın antiviral tedaviye uyumunu olumsuz yönde etkileyecek ve hastalığın gidiş ve sonlanmasını kötüleştirebilecektir. Bu derlemede, güncel çalışmalara dayanarak kronik hepatitli hastalarda görülen psikiyatrik belirtilerin yaygınlığı, fizyopatolojisi, interferonla ilişkisi ve tedavisini değerlendirmeyi amaçladık.

Chronic hepatitis from a psychiatric point of view

Psychiatric symptoms are commonly seen in the course of chronic hepatitis B and C virus infections. Because of the higher comorbidity of alcohol and substance use disorders, active participation of psychiatrists are required with crucial importance in the management chronic hepatitis patients. The management of such patients requires a multidisciplinary approach and consultation-liaison psychiatrists play an important role in this teamwork. Nowadays, there has been no consensus regarding the therapy of chronic hepatitis patients with psychiatric disorders. In the recent guidelines, the presence of depression and alcohol use disorders prior to antiviral therapy causes up to 6 months delay of the therapies; therefore, detailed psychosocial evalution is offered before the treatment of chronic hepatitis. If a psychiatric disorder of a patient with chronic hepatitis is missed and not treated, patients compliance to antiviral therapy will be affected negatively, and may worsen the progress and prognosis of the disease. In this review, we aimed to evaluate the prevalence, physiopathology, relationship with interferon and treatment of psychiatric symptoms seen in patients with chronic hepatitis, based on the recent studies.

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