School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Clin Transl Gastroenterol. 2020 Apr;11(4):e00159. doi: 10.14309/ctg.0000000000000159.
Hepatic encephalopathy (HE) is common in advanced cirrhosis and is characterized by marked neuropsychiatric abnormalities. However, despite its severity and effects on brain function, the impact of HE on psychological status of patients has not been adequately assessed. The aim of this study was to evaluate the effect of HE on psychological status of patients and their informal caregivers.
Fifteen patients with cirrhosis and episodic or persistent HE and their corresponding informal caregivers were included. Semistructured interviews were performed in patients and caregivers. Quality of life (QoL) was assessed by the short-form 36 in both patients and caregivers, and the Zarit burden score was measured in caregivers. The analysis of interviews was performed using qualitative methodology.
HE causes a major psychological impact on patients with HE. The first episode of HE caused a very significant impact that was reported with deep feelings, mainly of fear, anger, misery, anxiety, and sorrow, which persisted with time. Symptoms causing more psychological impact on patients were impaired ability to walk and speak. All effects were associated with a marked impairment in QoL. The psychological impact was also marked in caregivers who had a major burden, as assessed by the Zarit score. Moreover, QoL, particularly the mental component score, was markedly impaired in caregivers in intensity similar to that of patients.
HE has a profound psychological impact on patients and their informal caregivers, associated with a marked negative influence on QoL. The psychological effects of HE on patients and caregivers should be evaluated and treated.
肝性脑病（HE）在肝硬化晚期较为常见，其特征为明显的神经精神异常。然而，尽管 HE 严重且对大脑功能有影响，但它对患者心理状态的影响尚未得到充分评估。本研究旨在评估 HE 对患者及其非正式照顾者心理状态的影响。
纳入了 15 例患有肝硬化和间歇性或持续性 HE 的患者及其相应的非正式照顾者。对患者和照顾者进行半结构化访谈。采用短式 36 项健康调查量表评估患者和照顾者的生活质量（QoL），采用 Zarit 负担量表评估照顾者的负担。采用定性方法对访谈进行分析。
HE 对 HE 患者造成了重大的心理影响。首次发生 HE 会产生非常显著的影响，患者用强烈的感受进行描述，主要是恐惧、愤怒、痛苦、焦虑和悲伤，这些感受随着时间的推移而持续存在。对患者造成更大心理影响的症状是行走和说话能力受损。所有影响都与 QoL 的明显下降有关。照顾者的心理影响也很明显，Zarit 评分显示他们负担沉重。此外，照顾者的 QoL，特别是心理成分评分，与患者的评分相似，明显受损。
HE 对患者及其非正式照顾者都有深远的心理影响，对 QoL 产生明显的负面影响。HE 对患者和照顾者的心理影响应进行评估和治疗。
