Neuropsychiatric and psychosocial issues of patients with hepatitis C infection: A selective literature review

Hepatitis Monthly

Volumn 13, Issue 1, 2013, Pages

  Modabbernia, Amirhossein ^a,b   Poustchi, Hossein ^a   Malekzadeh, Reza ^a  

^a TEHRAN UNIVERSITY OF MEDICAL SCIENCES   (Iran)

^b TEHRAN UNIVERSITY OF MEDICAL SCIENCES   (Iran)

Author keywords

Anxiety; Depression; Fatigue; Hepatitis C; Mental health; Neurobehavioral manifestations; Social stigma

Indexed keywords

ALPHA INTERFERON; AMANTADINE; AMFEBUTAMONE; ANTIHISTAMINIC AGENT; ARMODAFINIL; BRAIN DERIVED NEUROTROPHIC FACTOR; CARNITINE; CITALOPRAM; CREATININE; CYCLIC AMP RESPONSIVE ELEMENT BINDING PROTEIN; GABAPENTIN; INTERFERON; INTERLEUKIN 6; LEPTIN; LEVACECARNINE; METHYLPHENIDATE; MIRTAZAPINE; MITOGEN ACTIVATED PROTEIN KINASE; MODAFINIL; ONDANSETRON; PEGINTERFERON; PROLACTIN; RIBAVIRIN; SEROTONIN UPTAKE INHIBITOR; TRAZODONE; ZALEPLON; ZOLPIDEM;

ACUTE CONFUSION; ANGER; AUTONOMIC NEUROPATHY; BRAIN DISEASE; COGNITIVE DEFECT; COPING BEHAVIOR; DEPRESSION; DISEASE ASSOCIATION; DRUG WITHDRAWAL; FATIGUE; HEPATITIS C; HUMAN; HYPERSOMNIA; IRON THERAPY; IRRITABILITY; LIVER CIRRHOSIS; MAJOR DEPRESSION; MANIA; MENTAL DISEASE; META ANALYSIS (TOPIC); MIXED INFECTION; MOOD DISORDER; NEUROLOGICAL COMPLICATION; NEUROPSYCHIATRY; PREVALENCE; PSYCHOSOMATIC DISORDER; QUALITY OF LIFE; RESTLESS LEGS SYNDROME; REVIEW; SIDE EFFECT; SLEEP DISORDER; SOCIAL PSYCHOLOGY; SOCIAL SUPPORT; STIGMA; SYSTEMATIC REVIEW (TOPIC);

EID: 84874101281     PISSN: 1735143X     EISSN: 17353408     Source Type: Journal    
DOI: 10.5812/hepatmon.8340     Document Type: Review

References (101)

1. Bonkovsky HL, Snow KK, Malet PF, Back-Madruga C, Fontana RJ, Sterling RK, et al. Health-related quality of life in patients with chronic hepatitis C and advanced fibrosis. J Hepatol. 2007;46(3):420-31.
2. Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335-74.
3. Crone C, Gabriel GM. Comprehensive review of hepatitis C for psychiatrists: risks, screening, diagnosis, treatment, and interferon-based therapy complications. J Psychiatr Pract. 2003;9(2):93-110.
4. Forton DM, Thomas HC, Taylor-Robinson SD. Quality of life and cognitive function in chronic hepatitis C - what to measure? J Hepatol. 2003;39(2):272-4.
5. Foster GR. Quality of life considerations for patients with chronic hepatitis C. J Viral Hepat. 2009;16(9):605-11.
6. Spiegel BM, Younossi ZM, Hays RD, Revicki D, Robbins S, Kanwal F. Impact of hepatitis C on health related quality of life: a systematic review and quantitative assessment. Hepatology. 2005;41(4):790-800.
7. Miller ER, McNally S, Wallace J, Schlichthorst M. The ongoing impacts of hepatitis c - a systematic narrative review of the literature. BMC Public Health. 2012;12(1):672.
8. Amodio P, Salari L, Montagnese S, Schiff S, Neri D, Bianco T, et al. Hepatitis C virus infection and health-related quality of life. World J Gastroenterol. 2012;18(19):2295-9.
9. Ashrafi M, Modabbernia A, Dalir M, Taslimi S, Karami M, Ostovaneh MR, et al. Predictors of mental and physical health in non-cirrhotic patients with viral hepatitis: A case control study. J Psychosom Res. 2012;73(3):218-24.
10. Foster GR, Goldin RD, Thomas HC. Chronic hepatitis C virus infection causes a significant reduction in quality of life in the absence of cirrhosis. Hepatology. 1998;27(1):209-12.
11. Modabbernia A, Ashrafi M, Keyvani H, Taslimi S, Poorkaveh A, Merat S, et al. Brain-derived neurotrophic factor predicts physical health in untreated patients with hepatitis C. Biol Psychiatry. 2011;70(5):e31-2.
12. Bondini S, Kallman J, Dan A, Younoszai Z, Ramsey L, Nader F, et al. Health-related quality of life in patients with chronic hepatitis B. Liver Int. 2007;27(8):1119-25.
13. Dan AA, Kallman JB, Wheeler A, Younoszai Z, Collantes R, Bondini S, et al. Health-related quality of life in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2007;26(6):815-20.
14. Forton DM, Allsop JM, Main J, Foster GR, Thomas HC, Taylor-Robinson SD. Evidence for a cerebral effect of the hepatitis C virus. Lancet. 2001;358(9275):38-9.
15. Forton DM, Thomas HC, Murphy CA, Allsop JM, Foster GR, Main J, et al. Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology. 2002;35(2):433-9.
16. Forton DM, Allsop JM, Cox IJ, Hamilton G, Wesnes K, Thomas HC, et al. A review of cognitive impairment and cerebral metabolite abnormalities in patients with hepatitis C infection. AIDS. 2005;19 Suppl 3:S53-63.
17. Forton DM, Taylor-Robinson SD, Thomas HC. Cerebral dysfunction in chronic hepatitis C infection. J Viral Hepat. 2003;10(2):81-6.
18. Hilsabeck RC, Perry W, Hassanein TI. Neuropsychological impairment in patients with chronic hepatitis C. Hepatology. 2002;35(2):440-6.
19. Kramer L, Hofer H, Bauer E, Funk G, Formann E, Steindl-Munda P, et al. Relative impact of fatigue and subclinical cognitive brain dysfunction on health-related quality of life in chronic hepatitis C infection. AIDS. 2005;19 Suppl 3:S85-92.
20. Bownik H, Saab S. The effects of hepatitis C recurrence on health-related quality of life in liver transplant recipients. Liver Int. 2010;30(1):19-30.
21. Poynard T, Cacoub P, Ratziu V, Myers RP, Dezailles MH, Mercadier A, et al. Fatigue in patients with chronic hepatitis C. J Viral Hepat. 2002;9(4):295-303.
22. Seaman K, Paterson BL, Vallis M, Hirsch G, Peltekian KM. Future directions for investigation of fatigue in chronic hepatitis C viral infection. Chronic Illn. 2009;5(2):115-28.
23. Racciatti D, Gorgoretti V, Sepede G, Gambi F, Pizzigallo E. An Italian study on health-related quality of life and fatigue in patients with chronic fatigue syndrome and patients with chronic HCV virus infection: similarities and differences. Int J Immunopathol Pharmacol. 2011;24(3):673-81.
24. Barkhuizen A, Rosen HR, Wolf S, Flora K, Benner K, Bennett RM. Musculoskeletal pain and fatigue are associated with chronic hepatitis C: a report of 239 hepatology clinic patients. Am J Gastroenterol. 1999;94(5):1355-60.
25. Hilsabeck RC, Hassanein TI, Perry W. Biopsychosocial predictors of fatigue in chronic hepatitis C. J Psychosom Res. 2005;58(2):173-8.
26. Anty R, Marjoux S, Bekri S, DeGalleani L, Dainese R, Gelsi E, et al. Plasma carnitine is associated with fatigue in chronic hepatitis C but not in the irritable bowel syndrome. Aliment Pharmacol Ther. 2011;33(8):961-8.
27. El-Gindy EM, Ali-Eldin FA, Meguid MA. Serum leptin level and its association with fatigue in patients with chronic hepatitis C virus infection. Arab J Gastroenterol. 2012;13(2):54-7.
28. Sarkar S, Jiang Z, Evon DM, Wahed AS, Hoofnagle JH. Fatigue before, during and after antiviral therapy of chronic hepatitis C: Results from the Virahep-C study. J Hepatol. 2012.
29. Felger JC, Alagbe O, Pace TW, Woolwine BJ, Hu F, Raison CL, et al. Early activation of p38 mitogen activated protein kinase is associated with interferon-alpha-induced depression and fatigue. Brain Behav Immun. 2011;25(6):1094-8.
30. Felger JC, Cole SW, Pace TW, Hu F, Woolwine BJ, Doho GH, et al. Molecular signatures of peripheral blood mononuclear cells during chronic interferon-alpha treatment: relationship with depression and fatigue. Psychol Med. 2012;42(8):1591-603.
31. Kronenberger B, Berg T, Herrmann E, Hinrichsen H, Gerlach T, Buggisch P, et al. Efficacy of amantadine on quality of life in patients with chronic hepatitis C treated with interferon-alpha and ribavirin: results from a randomized, placebo-controlled, double-blind trial. Eur J Gastroenterol Hepatol. 2007;19(8):639-46.
32. Malaguarnera M, Vacante M, Bertino G, Neri S, Gargante MP, Motta M, et al. The supplementation of acetyl-L-carnitine decreases fatigue and increases quality of life in patients with hepatitis C treated with pegylated interferon-alpha 2b plus ribavirin. J Interferon Cytokine Res. 2011;31(9):653-9.
33. Martin KA, Krahn LE, Balan V, Rosati MJ. Modafinil's use in combating interferon-induced fatigue. Dig Dis Sci. 2007;52(4):893-6.
34. Rabkin JG, McElhiney MC, Rabkin R. Modafinil and armodafinil treatment for fatigue for HIV-positive patients with and without chronic hepatitis C. Int J STD AIDS. 2011;22(2):95-101.
35. Goulding C, O'Connell P, Murray FE. Prevalence of fibromyalgia, anxiety and depression in chronic hepatitis C virus infection: relationship to RT-PCR status and mode of acquisition. Eur J Gastroenterol Hepatol. 2001;13(5):507-11.
36. Kozanoglu E, Canataroglu A, Abayli B, Colakoglu S, Goncu K. Fibromyalgia syndrome in patients with hepatitis C infection. Rheumatol Int. 2003;23(5):248-51.
37. Mohammad A, Carey JJ, Storan E, Scarry M, Coughlan RJ, Lee JM. Prevalence of fibromyalgia among patients with chronic hepatitis C infection: relationship to viral characteristics and quality of life. J Clin Gastroenterol. 2012;46(5):407-12.
38. Mohammed RH, ElMakhzangy HI, Gamal A, Mekky F, El Kassas M, Mohammed N, et al. Prevalence of rheumatologic manifestations of chronic hepatitis C virus infection among Egyptians. Clin Rheumatol. 2010;29(12):1373-80.
39. Morasco BJ, Huckans M, Loftis JM, Woodhouse J, Seelye A, Turk DC, et al. Predictors of pain intensity and pain functioning in patients with the hepatitis C virus. Gen Hosp Psychiatry. 2010;32(4):413-8.
40. Rifai MA, Indest D, Loftis J, Hauser P. Psychiatric management of the hepatitis C patient. Curr Treat Options Gastroenterol. 2006;9(6):508-19.
41. Schaefer M, Capuron L, Friebe A, Diez-Quevedo C, Robaeys G, Neri S, et al. Hepatitis C infection, antiviral treatment and Mental Health: A European Expert Consensus Statement. J Hepatol. 2012.
42. Rifai MA, Gleason OC, Sabouni D. Psychiatric care of the patient with hepatitis C: a review of the literature. Prim Care Companion J Clin Psychiatry. 2010;12(6)
43. McMahon JM, Tortu S. A potential hidden source of hepatitis C infection among noninjecting drug users. J Psychoactive Drugs. 2003;35(4):455-60.
44. el-Serag HB, Kunik M, Richardson P, Rabeneck L. Psychiatric disorders among veterans with hepatitis C infection. Gastroenterology. 2002;123(2):476-82.
45. Fontana RJ, Hussain KB, Schwartz SM, Moyer CA, Su GL, Lok AS. Emotional distress in chronic hepatitis C patients not receiving antiviral therapy. J Hepatol. 2002;36(3):401-7.
46. Zickmund S, Hillis SL, Barnett MJ, Ippolito L, LaBrecque DR. Hepatitis C virus-infected patients report communication problems with physicians. Hepatology. 2004;39(4):999-1007.
47. Gitto S, Micco L, Conti F, Andreone P, Bernardi M. Alcohol and viral hepatitis: a mini-review. Dig Liver Dis. 2009;41(1):67-70.
48. Raison CL, Demetrashvili M, Capuron L, Miller AH. Neuropsychiatric adverse effects of interferon-alpha: recognition and management. CNS Drugs. 2005;19(2):105-23.
49. Ping F, Shang J, Zhou J, Zhang H, Zhang L. 5-HT(1A) receptor and apoptosis contribute to interferon-alpha-induced "depressive-like" behavior in mice. Neurosci Lett. 2012;514(2):173-8.
50. Kenis G, Prickaerts J, van Os J, Koek GH, Robaeys G, Steinbusch HW, et al. Depressive symptoms following interferon-alpha therapy: mediated by immune-induced reductions in brain-derived neurotrophic factor? Int J Neuropsychopharmacol. 2011;14(2):247-53.
51. Udina M, Castellvi P, Moreno-Espana J, Navines R, Valdes M, Forns X, et al. Interferon-induced depression in chronic hepatitis C: a systematic review and meta-analysis. J Clin Psychiatry. 2012;73(8):1128-38.
52. McNutt MD, Liu S, Manatunga A, Royster EB, Raison CL, Woolwine BJ, et al. Neurobehavioral effects of interferon-alpha in patients with hepatitis-C: symptom dimensions and responsiveness to paroxetine. Neuropsychopharmacology. 2012;37(6):1444-54.
53. Baraldi S, Hepgul N, Mondelli V, Pariante CM. Symptomatic treatment of interferon-alpha-induced depression in hepatitis C: a systematic review. J Clin Psychopharmacol. 2012;32(4):531-43.
54. Kelly EM, Corace K, Emery J, Cooper CL. Bipolar patients can safely and successfully receive interferon-based hepatitis C antiviral treatment. Eur J Gastroenterol Hepatol. 2012;24(7):811-6.
55. Sheridan DA, Price DA, Schmid ML, Toms GL, Donaldson P, Neely D, et al. Apolipoprotein B-associated cholesterol is a determinant of treatment outcome in patients with chronic hepatitis C virus infection receiving anti-viral agents interferon-alpha and ribavirin. Aliment Pharmacol Ther. 2009;29(12):1282-90.
56. Navines R, Castellvi P, Moreno-Espana J, Gimenez D, Udina M, Canizares S, et al. Depressive and anxiety disorders in chronic hepatitis C patients: reliability and validity of the Patient Health Questionnaire. J Affect Disord. 2012;138(3):343-51.
57. Sockalingam S, Abbey SE, Alosaimi F, Novak M. A review of sleep disturbance in hepatitis C. J Clin Gastroenterol. 2010;44(1):38-45.
58. Sockalingam S, Shammi C, Stergiopoulos V. Managing the neuropsychiatric complications of hepatitis C treatment. Br J Hosp Med (Lond). 2007;68(10):520-5.
59. Fletcher NF, McKeating JA. Hepatitis C virus and the brain. J Viral Hepat. 2012;19(5):301-6.
60. Hilsabeck RC, Hassanein TI, Carlson MD, Ziegler EA, Perry W. Cognitive functioning and psychiatric symptomatology in patients with chronic hepatitis C. J Int Neuropsychol Soc. 2003;9(6):847-54.
61. Weissenborn K, Krause J, Bokemeyer M, Hecker H, Schuler A, Ennen JC, et al. Hepatitis C virus infection affects the brain-evidence from psychometric studies and magnetic resonance spectroscopy. J Hepatol. 2004;41(5):845-51.
62. Huckans M, Seelye A, Woodhouse J, Parcel T, Mull L, Schwartz D, et al. Discounting of delayed rewards and executive dysfunction in individuals infected with hepatitis C. J Clin Exp Neuropsychol. 2011;33(2):176-86.
63. Kramer L, Bauer E, Funk G, Hofer H, Jessner W, Steindl-Munda P, et al. Subclinical impairment of brain function in chronic hepatitis C infection. J Hepatol. 2002;37(3):349-54.
64. Perry W, Hilsabeck RC, Hassanein TI. Cognitive dysfunction in chronic hepatitis C: a review. Dig Dis Sci. 2008;53(2):307-21.
65. Quarantini LC, Miranda-Scippa A, Batista-Neves S, Powell VB, Abreu N, Abreu KC, et al. A neuropsychological study comparing patients infected with HCV and HBV without psychiatric comorbidities. J Med Virol. 2009;81(7):1184-8.
66. Lowry D, Coughlan B, McCarthy O, Crowe J. Investigating health-related quality of life, mood and neuropsychological test performance in a homogeneous cohort of Irish female hepatitis C patients. J Viral Hepat. 2010;17(5):352-9.
67. Rodrigue JR, Balistreri W, Haber B, Jonas MM, Mohan P, Molleston JP, et al. Impact of hepatitis C virus infection on children and their caregivers: quality of life, cognitive, and emotional outcomes. J Pediatr Gastroenterol Nutr. 2009;48(3):341-7.
68. Fontana RJ, Bieliauskas LA, Back-Madruga C, Lindsay KL, Litman HJ, Lok AS, et al. Cognitive function does not worsen during long-term low-dose peginterferon therapy in patients with chronic hepatitis C. Am J Gastroenterol. 2010;105(7):1551-60.
69. Byrnes V, Miller A, Lowry D, Hill E, Weinstein C, Alsop D, et al. Effects of anti-viral therapy and HCV clearance on cerebral metabolism and cognition. J Hepatol. 2012;56(3):549-56.
70. Monaco S, Ferrari S, Gajofatto A, Zanusso G, Mariotto S. HCV-Related Nervous System Disorders. Clin Dev Immunol. 2012;2012:236148.
71. Pattullo V, McAndrews MP, Damyanovich A, Heathcote EJ. Influence of hepatitis C virus on neurocognitive function in patients free from other risk factors: validation from therapeutic outcomes. Liver Int. 2011;31(7):1028-38.
72. Weissenborn K, Ennen JC, Bokemeyer M, Ahl B, Wurster U, Tillmann H, et al. Monoaminergic neurotransmission is altered in hepatitis C virus infected patients with chronic fatigue and cognitive impairment. Gut. 2006;55(11):1624-30.
73. Martin-Thormeyer EM, Paul RH. Drug abuse and hepatitis C infection as comorbid features of HIV associated neurocognitive disorder: neurocognitive and neuroimaging features. Neuropsychol Rev. 2009;19(2):215-31.
74. Crystal H, Kleyman I, Anastos K, Lazar J, Cohen M, Liu C, et al. Effects of hepatitis C and HIV on cognition in women: data from the Women's Interagency HIV Study. J Acquir Immune Defic Syndr. 2012;59(2):149-54.
75. Blacklaws H, Gardner A, Usher K. Irritability: an underappreciated side effect of interferon treatment for chronic hepatitis C? J Clin Nurs. 2011;20(9-10):1215-24.
76. Lotrich FE, Ferrell RE, Rabinovitz M, Pollock BG. Labile anger during interferon alfa treatment is associated with a polymorphism in tumor necrosis factor alpha. Clin Neuropharmacol. 2010;33(4):191-7.
77. Bezemer G, Van Gool AR, Fekkes D, Vrolijk JM, Hansen BE, Janssen HL, et al. Psychiatric side effects and fluctuations in serotonergic parameters in the treatment of chronic hepatitis C infection. Neuropsychobiology. 2012;65(3):126-32.
78. Butt G. Stigma in the context of hepatitis C: concept analysis. J Adv Nurs. 2008;62(6):712-24.
79. Butt G, Paterson BL, McGuinness LK. Living with the stigma of hepatitis C. West J Nurs Res. 2008;30(2):204-21. discussion 222-33
80. Zickmund S, Ho EY, Masuda M, Ippolito L, LaBrecque DR. "They treated me like a leper". Stigmatization and the quality of life of patients with hepatitis C. J Gen Intern Med. 2003;18(10):835-44.
81. Golden J, Conroy RM, O'Dwyer AM, Golden D, Hardouin JB. Illness-related stigma, mood and adjustment to illness in persons with hepatitis C. Soc Sci Med. 2006;63(12):3188-98.
82. Grundy G, Beeching N. Understanding social stigma in women with hepatitis C. Nurs Stand. 2004;19(4):35-9.
83. Schafer A, Scheurlen M, Felten M, Kraus MR. Physician-patient relationship and disclosure behaviour in chronic hepatitis C in a group of German outpatients. Eur J Gastroenterol Hepatol. 2005;17(12):1387-94.
84. Moore GA, Hawley DA, Bradley P. Hepatitis C: studying stigma. Gastroenterol Nurs. 2008;31(5):346-52.
85. Moore GA, Hawley DA, Bradley P. Hepatitis C: experiencing stigma. Gastroenterol Nurs. 2009;32(2):94-104.
86. Kraus MR, Schafer A, Csef H, Scheurlen M, Faller H. Emotional state, coping styles, and somatic variables in patients with chronic hepatitis C. Psychosomatics. 2000;41(5):377-84.
87. Grassi L, Satriano J, Serra A, Biancosino B, Zotos S, Sighinolfi L, et al. Emotional stress, psychosocial variables and coping associated with hepatitis C virus and human immunodeficiency virus infections in intravenous drug users. Psychother Psychosom. 2002;71(6):342-9.
88. Sanyal C, Ingram EL, Sketris IS, Peltekian KM, Kirkland S. Coping strategies used by patients infected with hepatitis C virus who are facing medication costs. Can J Hosp Pharm. 2011;64(2):131-40.
89. Treloar C, Hopwood M. "Look, I'm fit, I'm positive and I'll be all right, thank you very much": coping with hepatitis C treatment and unrealistic optimism. Psychol Health Med. 2008;13(3):360-6.
90. Blasiole JA, Shinkunas L, Labrecque DR, Arnold RM, Zickmund SL. Mental and physical symptoms associated with lower social support for patients with hepatitis C. World J Gastroenterol. 2006;12(29):4665-72.
91. Evon DM, Esserman DA, Ramcharran D, Bonner JE, Fried MW. Social support and clinical outcomes during antiviral therapy for chronic hepatitis C. J Psychosom Res. 2011;71(5):349-56.
92. Evon DM, Ramcharran D, Belle SH, Terrault NA, Fontana RJ, Fried MW. Prospective analysis of depression during peginterferon and ribavirin therapy of chronic hepatitis C: results of the Virahep-C study. Am J Gastroenterol. 2009;104(12):2949-58.
93. Rowan PJ, Al-Jurdi R, Tavakoli-Tabasi S, Kunik ME, Satrom SL, El-Serag HB. Physical and psychosocial contributors to quality of life in veterans with hepatitis C not on antiviral therapy. J Clin Gastroenterol. 2005;39(8):731-6.
94. Cormier M. The role of hepatitis C support groups. Gastroenterol Nurs. 2005;28(3 Suppl):S4-9.
95. Edlin BR, Kresina TF, Raymond DB, Carden MR, Gourevitch MN, Rich JD, et al. Overcoming barriers to prevention, care, and treatment of hepatitis C in illicit drug users. Clin Infect Dis. 2005;40 Suppl 5:S276-85.
96. Loftis JM, Matthews AM, Hauser P. Psychiatric and substance use disorders in individuals with hepatitis C: epidemiology and management. Drugs. 2006;66(2):155-74.
97. Khokhar OS, Lewis JH. Reasons why patients infected with chronic hepatitis C virus choose to defer treatment: do they alter their decision with time? Dig Dis Sci. 2007;52(5):1168-76.
98. Hatem C, Minello A, Bresson-Hadni S, Jooste V, Evrard P, Obert B, et al. Is the management of hepatitis C patients appropriate? A population-based study. Aliment Pharmacol Ther. 2005;21(8):1007-15.
99. Jecker NS. Caring for "socially undesirable" patients. Camb Q Healthc Ethics. 1996;5(4):500-10.
100. Lang JP, Michel L, Melin P, Schoeffler M, Gauchet A, Rousseaux C, et al. Management of psychiatric disorders and addictive behaviors in patients with viral hepatitis C in France. Gastroenterol Clin Biol. 2009;33(1 Pt 1):1-7.
101. Knott A, Dieperink E, Willenbring ML, Heit S, Durfee JM, Wingert M, et al. Integrated psychiatric/medical care in a chronic hepatitis C clinic: effect on antiviral treatment evaluation and outcomes. Am J Gastroenterol. 2006;101(10):2254-62.