Depression metabolic encephalopathy

Major Depression and Metabolic Encephalopathy Syndromes More Alike Than Not ... 

While I have focused primarily on the neuropsychiatry of HE, a number of diverse liver diseases that present with metabolic encephalopathies can be linked to mood dysregulation and depression. This would include illnesses such as hepatolenticular degeneration (Wilson s disease) (Eggers et al., 2003 Hesse et al, 2003 Chan et al., 2005), Gaucher disease (Packman et al., 2006), Fabry disease (Sadek et al., 2004), and hepatitis C infection (Forton et al., 2004). Thus, both the presentation... 

IV. Diagnosis is based on the history of exposure and typical findings of CNS depression and metabolic disturbances. The differential diagnosis is broad and in-oludes most CNS depressants. Encephalopathy and hyperammonemia may mimio Reye s syndrome. 

A study, undertaken to confirm the involvement of the cytochrome P450 isoenzyme CYT2D6 in the metabolism of trazodone, found that when 11 depressed patients were given trazodone 150 to 300 mg at bedtime for 18 weeks, and then with thioridazine 20 mg twice daily for one week, the plasma levels of the trazodone and its active metabolite, /w-chlorophenyl-piperazine, rose by 36% and 54%, respectively. No adverse reactions were described. In contrast, a case of fatal hepatic necrosis with cholestasis has been attributed to the concurrent use of trazodone and phenothiazines. A 72-year-old woman taking trifluoperazine, trazodone and lithium carbonate developed an elevated alanine aminotransferase level. Trifluoperazine was replaced with thioridazine, but 9 weeks later she became jaundiced and developed hepatic encephalopathy, and died 6 weeks after the onset of jaundice. The authors consider that the combination of the phenothiazines and trazodone were the cause of her hepatic necrosis both phenothiazines and trazodone have been reported to individually cause hepatic adverse effects. ... 

Niacin deficiency leads to unwanted multisystemic problems that are often associated with dermatological changes. Pellagra is a condition in which niacin deficiency causes a symmetrical pigmented rash, thickened skin and superficial scaling which are found in sun-exposed body areas. The classic triad of niacin deficiency are the three D s—dermatitis, diarrhoea and dementia (Hegyi et al. 2004). Some of the effects on the central nervous system include depression, anxiety, restlessness and poor concentration. In addition, alcoholic individuals with poor nutrition can develop pellagroid encephalopathy (Cook et al. 1998). The role of niadn deficiency in cardiovascular disease and lipid metabolism remains to be fully explored. 

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