Metabolic Brain Disease

, Volume 28, Issue 2, pp 235–238 | Cite as

Organic delirious states and other psychiatric disorders: lessons for the hepatologists

  • Raben Rosenberg
  • Signe Groth Renvillard
  • Simon Hjerrild
Original Paper


Hepatic encephalopathy (HE) is characterized by a wide variety of neuropsychiatric symptoms, and from a psychiatric perspective its nosological status calls for clarification. According to the ICD-10 classification, it can be classified as delirium due to overt HE´s core symptom of clouding of consciousness in increasing degrees. Minimal/covert HE with impairment of neurocognitive function is more difficult to classify and could correspond to Mild Cognitive Impairment or mild degrees of dementia. However, the advantages of current psychiatric nosology is the possibility of thorough characterization of both dispositional and premorbid psychopathology as well as psychiatric morbidity induced by liverdiseases or even treatment. A future closer collaboration between hepatologists and psychiatrists is advocated.


Hepatic encephalopathy Psychopathology Psychiatric classification Psychiatry Nosology 


  1. Prakash R, Mullen KD (2010) Mechanisms, diagnosis and management of hepatic encephalopathy. Nat Rev Gastroenterol Hepatol 7(9):515–525PubMedCrossRefGoogle Scholar
  2. Rivera Ramos JF, Rodriguez Leal C (2011) Review of the final report of the 1998 Working Party on definition, nomenclature and diagnosis of hepatic encephalopathy. Ann Hepatol 10(Suppl 2):S36–S39PubMedGoogle Scholar
  3. Randolph C, Hilsabeck R, Kato A, Kharbanda P, Li YY, Mapelli D et al (2009) Neuropsychological assessment of hepatic encephalopathy: ISHEN practice guidelines. Liver Int 29(5):629–635PubMedCrossRefGoogle Scholar
  4. Cordoba J (2011) New assessment of hepatic encephalopathy. J Hepatol 54(5):1030–1040PubMedCrossRefGoogle Scholar
  5. Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H (2001) Neuropsychological characterization of hepatic encephalopathy. J Hepatol 34(5):768–773PubMedCrossRefGoogle Scholar
  6. Kappus MR, Bajaj JS (2012) Covert hepatic encephalopathy: Not as minimal as you might think. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological AssociationGoogle Scholar
  7. World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organization, Geneva, pp 1–362Google Scholar
  8. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, pp 1–886Google Scholar
  9. Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM et al (2011) Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 7(3):280–292PubMedCrossRefGoogle Scholar
  10. Dwight MM, Kowdley KV, Russo JE, Ciechanowski PS, Larson AM, Katon WJ (2000) Depression, fatigue, and functional disability in patients with chronic hepatitis C. J Psychosom Res 49(5):311–317PubMedCrossRefGoogle Scholar
  11. Schaefer M, Hinzpeter A, Mohmand A, Janssen G, Pich M, Schwaiger M et al (2007) Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin: response and psychiatric side effects. Hepatology 46(4):991–998PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Raben Rosenberg
    • 1
  • Signe Groth Renvillard
    • 1
  • Simon Hjerrild
    • 1
  1. 1.Centre for Psychiatric ResearchAarhus University Hospital RisskovRisskovDenmark

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