Anxiety and depression symptoms in hepatic encephalopathy: are they psychiatric or organic?

Hepatic encephalopathy (HE) represents a broad continuum of neuropsychiatric abnormalities, from subtly altered mental status to deep coma, seen in patients with liver dysfunction. HE can mimic all of the major psychiatric syndromes. The distinction between HE and a psychiatric condition, namely depression, is sometimes difficult. Some liver patients end up being medicated with psychiatric drugs which might worsen their medical state. The main objective of this study was to try to find the correlations between anxiety and depression symptoms and the presence of HE to better diagnose and treat these patients.

Sixty consecutive liver transplant candidates, attending the outpatient clinics of a liver transplantation center were studied from January 1, 2012, to December 1, 2012. Each patient was assessed by means of Psychometric Hepatic Encephalopathy Score subtests and Hospital Anxiety and Depression Scale.

We found a statistically significant relationship between HE and some of the depressive symptoms: anhedonia and loss of energy.

These findings may indicate that when in the presence of an HE patient with depressive symptoms, HE-directed therapies should be attempted before antidepressant drugs.