177 BEHAVIOR DISORDERS IN CIRRHOTIC PATIENTS AND THEIR RELATIONSHIP WITH HEALTH RELATED QUALITY OF LIFE (HRQOL)

Background and Aim: Cirrhosis is an important chronic disease worldwide. The relationship between cirrhosis and behavior disorders, such as depression, anxiety and alexithymia is unknown. The aim of this study was investigating the prevalence of these psychiatric symptoms in cirrhotics and their relationship with HRQoL and minimal hepatic encephalopathy (MHE). Patients/methods: 39 cirrhotics (29M, Age 64±12; Child– A/B/C = 21/15/3), consecutively observed without evidence of severe cognitive impairment (Mini Mental State Examination >26) and overt HE (excluded by West Haven criteria and CHESS score), underwent an extensive neuropsychological assessment, including ZUNG-Self Depression Rating Scale (Zung-SDS), the State-Trait Anxiety Inventory Y1-Y2 (S.T.A.I.) for state and trait anxiety and the Toronto Alexithymia Scale-20 items (TAS-20). These tests were specifically chosen because they explore the fronto-subcortical circuits, which are probably involved in patients with MHE. Patients were examined for MHE detection using the psychometric hepatic encephalopathy score (PHES), adjusted for age and education of healthy Italian population. HRQoL was evaluated by Short Form36 questionnaire corrected for age, education and occupation of healthy Italian population. Results: Depression (ZUNG-SDS ≥50) was detected in 24 patients (62%, 95%CI = 46–77%), state anxiety (STAI-Y1 ≥60) in 12 patients (31%, 95%CI = 16–46%), trait anxiety (STAI-Y2 ≥60) in 12 patients (31%, 95%CI = 16–46%) and alexithymia (TAS-20 ≥60) in 12 patients (31% 95%CI = 16–46%). At least one behavioural test was pathological in 26 patients (67% 95%CI = 51–82%). MHE (diagnosed as PHES ≤−4) was detected in 14 cirrhotics (36% 95%CI = 20–52%). The number of patients with at least one altered behavioural test was similar in the two groups of patients with and without MHE (9 vs 17; p =NS). HRQoL was compromised in vitality, social functioning and mental health in depressed patients. State anxiety did not worsen HRQoL, while trait anxiety impaired bodily pain, vitality and mental health. Moreover, alexithymia impaired HRQoL in all domains, but bodily pain and mental health (Figures). Conclusions: Depression, state and trait anxiety and alexithymia are frequent in cirrhotic patients. These conditions, overall alexithymia, have a negative impact on HRQoL and are not related to MHE.