A Longitudinal Study Evaluating the Effects of Interferon-Alpha Therapy on Cognitive and Psychiatric Function in Adults with Chronic Hepatitis C

Objective: To prospectively evaluate for changes in objective cognitive performance (attention, memory, and executive function) and psychiatric symptom severity (depression, anxiety, fatigue, and pain) in patients before, during and after interferon-alpha based therapy (IFN) for chronic hepatitis C virus infection (HCV). Methods: 33 HCV+ adults were evaluated two months before IFN initiation (baseline), three months into IFN, and six months following IFN termination (IFN+ Group). 31 HCV+ adults who did not undergo IFN therapy were evaluated at baseline and six months later (IFN− Group). At each evaluation, participants completed the Neuropsychological Assessment Battery (NAB) Attention, Memory and Executive Functions Modules, the Beck Depression Inventory, Second Edition (BDI), Generalized Anxiety Disorder Inventory (GADI), Fatigue Severity Scale (FSS), and Brief Pain Inventory (BPI). Results: Compared with the IFN− Group, the IFN+ Group experienced significantly (p b 0.050) increased symp-toms of depression, anxiety, fatigue and pain during IFN therapy relative to baseline. In the IFN+ Group, psychi-atric symptoms generally returned to baseline levels following IFN termination. Sustained viral response was associated with significantly lower depression and fatigue. No significant changes in cognitive performance were observed. Conclusions: During IFN, patients with HCV evidence significantly increased psychiatric symptoms, including symptoms of depression, anxiety, fatigue and pain. These psychiatric symptoms are generally short-term and remit following IFN termination, with increased benefit if viral clearance is achieved. However, IFN is not associated with significant declines in objective cognitive performance during or following IFN

Performance effort, neuropsychological, and psychological test scores in litigant and nonlitigant populations

The Word Memory Test (WMT) is a performance validity test used to evaluate if an examinee’s effort during neuropsychological testing is sufficient to obtain valid results. It is designed to detect suboptimal effort or exaggeration of symptoms while being insensitive to all but the most severe forms of cognitive dysfunction. Most studies to date on the WMT have used samples involved in criminal or civil litigation and research using nonlitigant clinical samples is scarce. The current study examined the relationship of WMT performance to neuropsychological test scores and Personality Assessment Inventory (PAI) scores in both litigant and nonlitigant participants. Results indicated that although those who “failed” the WMT obtained significantly lower neuropsychological test scores than those who passed, mean neuropsychological performance was within the average range for both groups. Patients who “failed” the WMT also had significantly higher scores on the Negative Impression scale on the PAI. Further, litigants in this sample were no more likely to “fail” the WMT than nonlitigants. Clinical implications of these results are discussed