Skip to main content
SpringerLink
Log in

Psychiatric Aspects of Portal-Systemic Encephalopathy

  • Published:
Metabolic Brain Disease Aims and scope Submit manuscript

Abstract

This paper focuses on psychiatric aspects of portal-systemic encephalopathy (PSE) due to chronic liver disease and/or portal-systemic shunting. Clinical syndromes of PSE are discussed from the point of view of biological psychiatry, but, psychological consequences of concomitant cognitive disorders are also addressed. Psychiatric symptoms of early PSE and sleep disorders in patients with chronic liver disease are of specific interest.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Adams, R.D. and Foley J.M. (1953). The neurological disorder associated with liver disease. Research Publ. A. Res. Nerv. Ment. Dis. 32:198–237.

    Google Scholar 

  • American Psychiatric Association (APA) (1994). Diagnostic and statistical manual of mental disorders, ed. 4. American Psychiatric Association, Washington/DC, USA.

    Google Scholar 

  • Basile, A.S. and Jones, E.A. (1997). Ammonia and GABA-ergic neurotransmission: interrelated factors in the pathogenesis of hepatic encephalopathy. Hepatol. 25:1303–1305.

    Google Scholar 

  • Bengtsson, F., Bergqvist, P.B. and Apelqvist, G. (1997). Brain tryptophan perturbation in hepatic encephalopathy: implications for effects by neuropsychoactive drugs in clinical practice. Adv. Exp. Med. Biol. 420:1–33.

    Google Scholar 

  • Butterworth, R.F. (1996). The neurobiology of hepatic encephalopathy. Semin. Liver Dis. 16:235–244.

    Google Scholar 

  • Butterworth, R.F. (1997). Hepatic Encephalopathy: Disorder of Multiple Neurotransmitter Systems. In (C. Record and H. Al-Mardini, eds), Advances in Hepatic Encephalopathy and Metabolism in Liver Disease. Ipswich Book Company, Newcastle upon Tyne, Great Britain, pp. 167–175.

    Google Scholar 

  • Chadwick, J. and Mann, W. (1950). The Medical Works of Hippocrates: "The Sacred Disease". Blackwell Scientific Publisher, Oxford, Great Britain, p. 191.

    Google Scholar 

  • Collis, I. and Lloyd, G. (1992). Psychiatric aspects of liver disease. Br. J. Psychia. 161:12–22.

    Google Scholar 

  • Conn, H.O. (1977). Trailmaking and number-connection tests in the assessment of mental state in portal-systemic encephalopathy. Am. J. Dig. Dis. 22:541–550.

    Google Scholar 

  • Conn, H.O. and Lieberthal, M.M. (1978a). Pathogenesis of portal-systemic encephalopathy. In The Hepatic Coma Syndromes and Lactulose. Williams & Wilkins, Baltimore/MD, pp. 46–84.

    Google Scholar 

  • Conn, H.O. and Lieberthal, M.M. (1978b). The syndrome of portal-systemic encephalopathy. In The Hepatic Coma Syndromes and Lactulose. Williams & Wilkins, Baltimore/MD, pp. 1–46

    Google Scholar 

  • Cordoba, J., Cabrera, J., Latif, L., Penev, P., Zee, P. and Blei, A.T. (1998). High prevalence of sleep disturbance in cirrhosis. Hepatol. 27:339–345.

    Google Scholar 

  • Davidson, E.A. and Summerskill, W.H.J. (1956). Psychiatric aspects of liver disease. Postgraduate Med. J. 32:487–494.

    Google Scholar 

  • Ewusi-Mensah, I., Saunders, J.B., Wodak, A.D., Murray, R.M. and Williams, R. (1983). Psychiatric morbidity in patients with alcoholic liver disease. Br. Med. J. 287:1417–1419.

    Google Scholar 

  • Ferenci, P. (1997). Diagnosis and differential diagnosis of hepatic encephalopathy: Implications for the design of clinical studies. In (C. Record and H. Al-Mardini, eds) Advances in Hepatic Encephalopathy and Metabolism in Liver Disease. Ipswich Book Company, Newcastle upon Tyne, Great Britain, pp. 267–272.

    Google Scholar 

  • Ferenci, P., Herneth, A. and Steindl, P. (1996). Newer approaches to therapy of hepatic encephalopathy. Semin. Liver Dis. 16:329–338.

    Google Scholar 

  • Gilberstadt, S.J., Gilberstadt, H., Zieve, L., Buegel, B., Collier, R.O. and McClain, C.J. (1980). Psychomotor performance defects in cirrhotic patients without overt encephalopathy. Arch. Intern. Med. 140:519–521.

    Google Scholar 

  • Groeneweg, M., Quero, J.C., Essink-Bot, M.L., Hop, W.C.J. and Schalm, S.W. (1997). The effect of subclinical hepatic encephalopathy on the quality of life. In (C. Record and H. Al-Mardini, eds) Advances in Hepatic Encephalopathy and Metabolism in Liver Disease. Ipswich Book Company, Newcastle upon Tyne, Great Britain, pp. 311–317.

    Google Scholar 

  • Inoue, E., Hori, S. and Narumi, Y. (1991). Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images. Radiol. 179:551–555.

    Google Scholar 

  • Jabbour, N., Zajko, A.B., Orons, P.D., Irish, W., Bartoli, F., Marsh, W.J. et al. (1996). Transjugular intrahepatic portosystemic shunt in patients with end-stage liver disease: results in 85 patients. Liver. Transpl. Surg. 2:139–147.

    Google Scholar 

  • Jalan, R., Gooday, R., Carroll, R.E., Redhead, D.N., Elton, R.A. and Hayes, P.C. (1995). A prospective evaluation of changes in neuropsychological and liver function tests following transjugular intrahepatic portosystemic stent-shunt. J. Hepatol. 23:697–705.

    Google Scholar 

  • Jones, E.A. and Weissenborn, K. (1997). Neurology and the liver. J. Neurol. Neurosurg. Psychiatry 63:279–293.

    Google Scholar 

  • Kornhuber, J., Wichart, I., Riederer, P., Kleinberger, G. and Jellinger, K. (1989). Kynurenine in hepatic encephalopathy. In (W. Stone, ed.), Quinolinic Acid and the Kynurenines. CRC Press, Boca Raton, USA, pp. 275–281.

    Google Scholar 

  • Moore, J.W., Dunk, A.A., Crawford, J.R., Deans, H., Besson, J.A., De Lacey, G. et al. (1989). Neuropsychological deficits and MRI brain scan abnormalities in apparently healthy non-encephalopathic patients with cirrhosis: a controlled study. J. Hepatol. 9:319–325.

    Google Scholar 

  • Mullen, K.D. and Gacad, R. (1996). Hepatic encephalopathy. Gastroenterol. 4:188–202.

    Google Scholar 

  • Nolte, W., Wiltfang, J., Schindler, C., Münke, H., Unterberg, K., Figulla, H.R. et al. (1998a). Portosystemic hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis: clinical, laboratory, psychometric and electroencephalographic investigations. Hepatol. (in press)

  • Nolte, W., Wiltfang, J., Schindler, C.G., Unterberg, K., Finkenstaedt, M., Niedmann, P.D. et al. (1998b). Bright basal ganglia in T1-weighted magnetic resonance images are frequent in patients with portal vein thrombosis without liver cirrhosis and not suggestive of hepatic encephalopathy. J. Hepatol. (in press)

  • Norenberg, M.D. (1996). Astrocytic-ammonia interactions in hepatic encephalopathy. Semin. Liver Dis. 16:245–253.

    Google Scholar 

  • Ohnishi, K., Saito, M., Sato, S., Nakayama, T., Takashi, M., Sida, S. et al. (1985). Direction of splenic venous flow assessed by pulsed doppler flowmetry in patients with large splenorenal shunt. Relation to spontaneous hepatic encephalopathy. Gastroenterol. 89:180–185.

    Google Scholar 

  • Paquet, K.J., Lazar A., Koussouris, P., Hotzel, B., Gad, H.A., Kuhn, R. and Kalk, J.F. (1995). Mesocaval interposition shunt with small-diameter polytetrafluoroethylene grafts in sclerotherapy failure. Br. J. Surg. 82:199–203.

    Google Scholar 

  • Parsons-Smith, G., Summerskill, W.H.J., Dawson, A.M. and Sherlock, S. (1957). The electroencephalograph in liver disease. Lancet 2:867–871.

    Google Scholar 

  • Planas, R., Gomes-Vieira, M.C., Cabre, E., Armengol, M., Quer, J.C., Boix, J., et al. (1992). Prognostic factors of hepatic encephalopathy after portacaval anastomosis: a multivariate analysis in 50 patients. Am. J. Gastroenterol. 87:1792–1796.

    Google Scholar 

  • Pomier Layrargues, G. (1996). TIPS and hepatic encephalopathy. Semin. Liver Dis. 16:315–320.

    Google Scholar 

  • Pomier Layrargues, G., Spahr, L. and Butterworth, R.F. (1995). Increased manganese concentrations in pallidum of cirrhotic patients. Lancet 345:735.

    Google Scholar 

  • Quero, J.C., de Bruijn, I., Hartmann, I.J.C. and Schalm, S.W. (1995). Does subclinical hepatic encephalopathy affect quality of life? [Abstract]. Gastroenterol. 108:1151A.

    Google Scholar 

  • Quero, J.C. and Schalm, S.W. (1996). Subclinical hepatic encephalopathy. Semin. Liver Dis. 16:321–328.

    Google Scholar 

  • Rehnstrom, S., Simert, G., Hansson, J.A., Johnsson, G. and Vang, J. (1977). Chronic hepatic encephalopathy: a psychometrical study. Scand. J. Gastroent. 12:305–311.

    Google Scholar 

  • Rikkers, L., Jenko, P., Rudman, D. and Freides, D. (1978). Subclinical hepatic encephalopathy: detection, prevalence, and relationship to nitrogen metabolism. Gastroent. 75:462–469.

    Google Scholar 

  • Rössle, M., Deibert, P., Haag, K., Ochs, A., Olschewski, M., Siegerstetter, V. et al. (1997). Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding. Lancet 349:1043–1049.

    Google Scholar 

  • Rössle, M., Siegerstetter, V., Huber, M. and Ochs, A. (1998). The first decade of the transjugular intrahepatic portosystemic shunt (TIPS): state of the art [review article]. Liver 18:73–89.

    Google Scholar 

  • Sanyal, A.J., Freedman, A.M., SHiffman, M.L., Purdum, P.P., Luketic, V.A. and Cheatham, A.K. (1994). Portosystemic encephalopathy after transjugular intrahepatic portosystemic shunt: results of a prospective controlled study. Hepatol. 20:46–55.

    Google Scholar 

  • Sarfeh, I.J., Rypins, E.B., Conroy, R.M. and Mason, G.R. (1983). Portacaval H-graft: relationships of shunt diameter, portal flow patterns and encephalopathy. Ann. Surg. 197:422–426.

    Google Scholar 

  • Sarin, S.K., Sachdev, G., Jildha, R.C., Siloah, R.C., Bhatt, A. and Munjal, G.C. (1988). Pattern of psychiatric morbidity and alcohol dependence in patients with alcoholic liver disease. Dig. Dis. Sci. 33:443–448.

    Google Scholar 

  • Schomerus, H., Hamster, W., Blunck, H., Reinhard, O., Mayer K. and Dolle, W. (1981). Latent portal-systemic encephalopathy. I. Nature of cerebral functional defects and their effects on fitness to drive. Dig. Dis. Sci. 26:622–630.

    Google Scholar 

  • Sherlock S. (1997). Hepatic Encephalopathy: Historical Review Up to 1975. In (C. Record and H. Al-Mardini, eds) Advances in Hepatic Encephalopathy and Metabolism in Liver Disease. Ipswich Book Company, Newcastle upon Tyne, Great Britain, pp. 159–163.

    Google Scholar 

  • Sherlock, S., Summerskill, L.P. and Phear, E.A. (1954). Portal-systemic encephalopathy. Neurological complications of liver disease. Lancet 2:453–457.

    Google Scholar 

  • Sherlock, S., Summerskill, W.H.J. and Dawson, A.M. (1956). The treatment and prognosis of hepatic coma. Lancet 2:689–694.

    Google Scholar 

  • Simen, S., Hajak, G., Schlaf, G., Westenhofer, J., Rodenbeck, A., Bandelow, B. et al. (1995). Chronification of sleep disorders. Results from a representative survey in West Germany. Nervenarzt 66:686–695.

    Google Scholar 

  • Somberg, K.A., Riegler, J.L., LaBerge, J.M., Doherty-Simor, M.M., Bachetti, P., Roberts, J.P. and Lake, J.R. (1995). Hepatic encephalopathy after transjugular intrahepatic protosystemic shunts: incidence and risk factors [see comments]. Am. J. Gastroenterol. 90:549–55.

    Google Scholar 

  • Spitzer, R.L., First, M.B., Williams, J.B.W., Kendler, K., Pincus, H.A. and Tucker, G. (1992). Now is the time to retire the term "organic mental disorders". Am. J. Psychiatry 49:240.

    Google Scholar 

  • Steindl, P.E., Finn, B., Bendok, B., Rothke, S., Zee, P.C. and Blei, A.T. (1995). Disruption of the diurnal rhythm of plasma melatonin in cirrhosis. Ann. Intern. Med. 123:274–277.

    Google Scholar 

  • Summerskill, W.H.J., Davidson, E.A., Sherlock, S. and Steiner, R.E. (1956). The neuropsychiatric syndrome associated with hepatic cirrhosis and an extensive portal collateral circulation. Quart. J. Med. 25:245–266.

    Google Scholar 

  • Surman, O.S. and Dienstag, J.L. (1987). Psychosomatic aspects of liver transplantation. Psychoth. Psychosomatics 48:26.

    Google Scholar 

  • Tarter, R.E., Hegedus, A.M., Van Thiel, D.H., Schade, R.R., Gavaler, J S. and Starzl, T.E. (1984). Nonalcoholic cirrhosis associated with neuropsychological dysfunction in the absence of overt evidence of hepatic encephalopathy. Gastroenterol. 86:1421–1427.

    Google Scholar 

  • Tarter, R.E., van Thiel, D.H. and Arria, A.M. (1988). Impact of Cirrhosis on neuropsychological test performance of alcoholics. Alcoholism 12:619–621.

    Google Scholar 

  • Trzepacz, P.T. and Dimartini, A. (1992). Survival of 247 liver transplant candidates. Relationship to pretransplant psychiatric variables and presence of delirium. General Hospital in Psychiatry 14:380.

    Google Scholar 

  • van der Rijt, C.C. and Schalm, S.W. (1992). Quantitative EEG analysis and evoked potentials to measure (latent) hepatic encephalopathy. J. Hepatol. 14:141–2.

    Google Scholar 

  • Victor, M., Adams, R.D. and Cole, M. (1965). The acquired (non-Wilsonian) type of chronic hepatocerebral degeneration. Medicine 44:345–396.

    Google Scholar 

  • Weissenborn, K., Ruckert, N., Hecker, H. and Manns, M.P. (1998). The number connection tests A and B: interindividual variability and use for the assessment of early hepatic encephalopathy [In Process Citation]. J. Hepatol. 28:646–53.

    Google Scholar 

  • Weissenborn, K., Scholz, M., Hinrichs, H., Wiltfang, J., Schmidt, F.W. and Kunkel, H. (1990). Neurophysiological assessment of early hepatic encephalopathy. Electroencephalogr. Clin. Neurophysiol. 75:289–295.

    Google Scholar 

  • Weissman, M.M., Myers, J.K. and Harding, P.S. (1977). Prevalence and psychiatric heterogeneity of alcoholism in the United States urban community. J. Studies on Alcohol 41:672–681.

    Google Scholar 

  • Wiltfang, J., Becker, H., Weißenborn, K., Thiel, A. and Manns, M. (1996). Prospective study on psychopathological syndromes in patients with non-alcohol-toxic liver cirrhosis awaiting liver transplantation [Abstract]. Europ. J. Gastroent. Hepat. 5(Suppl):15A

    Google Scholar 

  • Wiltfang, J., Nolte, W., Figulla, H.R., Münke, H., Hartmann, H., von Heppe, J. et al. (1997). Organic Insomnia Following Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS). In (C. Record and Al-Mardini, eds) Advances in Hepatic Encephalopathy and Metabolism in Liver Disease. Ipswich Book Company, Newcastle upon Tyne, Great Britain, pp. 273–278.

    Google Scholar 

  • Zeegen, R., Drinkwater, J.E. and Dawson, A.M. (1970). Method for measuring cerebral dysfunction in patients with liver disease. Br. Med. J. 2:633–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept. of Psychiatry, Division Gastroenterology and Endocrinology, University of Göttingen. Dept. of Psychiatry, University of Göttingen, Goettingen, Germany

    J. Wiltfang, J. Kornhuber & E. Rüther

  2. Dept. of Internal Medicine, Division Gastroenterology and Endocrinology, University of Göttingen, Germany

    W. Nolte

  3. Dept. of Neurology, Medizinische Hochschule Hannover, Germany

    K. Weißenborn

Authors
  1. J. Wiltfang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Nolte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Weißenborn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Kornhuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Rüther
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Wiltfang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wiltfang, J., Nolte, W., Weißenborn, K. et al. Psychiatric Aspects of Portal-Systemic Encephalopathy. Metab Brain Dis 13, 379–389 (1998). https://doi.org/10.1023/A:1020697127718

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1020697127718

Search

Navigation