الفهرس 
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Abstract
Chronic hepatitis C by itself as well as treatment with interferon alpha and ribavirin are often associated with poor quality of life and psychiatric problems .More than 30% of patients chronically infected with HCV who have not yet received standard combination therapy show neuropsychiatric disorders.
Neuropsychiatric side effects may reduce the patient quality of life during treatment. Moreover psychiatric side effects, such as depression, during interferon alpha treatment may lead to dose reduction and treatment discontinuation, followed by reduced sustained virological response.
This prospective clinical cohort study was carried out in Ismailia center for treatment of viral hepatitis in Ismailia Fever Hospital from December 2011 to September 2012.It included 133 patients, their age was from20-58 (41.20 ± 10.51).
Required data were collected from patients by using questionnaire. The questionnaire consisted of five parts: personal data follow up investigations, patients’ symptoms, Beck Questionnaire for assessment of depression& Questionnaire for assessment of HRQOL. Patients were assessed at week 0 (before starting treatment), after the 4th week and after the 12th week.
HRQOL:
Before treatment the total score was 60.56 ± 20.7 which was impaired and became 85.0 ± 27.6 at the 4th week and 101.6 ± 25.6 at the 12th week with significant p-value <0.001 for both. Before treatment, the most affected domain was psychological domain. At week 4, the most affected domain was the psychological domain and the domain which was most impaired compared to pre-treatment assessment was the social domain with p-value <0.001. At week 12, the most affected domain was health perception domain and it was also the most impaired domain compared to pre-treatment assessment with p- value <0.001.While comparing week 4 with week 12 the most impaired domain was health perception domain with p-value <0.001.
At week 12: HRQOL was better in patients who had Peg-IFN dose reduction (99.83 ± 20.63) compared to (101.76 ± 26.05) in patients with no IFN dose reduction. Also HRQOL was better in patients who had Ribavirin dose reduction (99.24 ± 27.08) compared to (102.63 ± 24.92) in patients with no Ribavirin dose reduction but with insignificant p-value.
At week 12: the total HRQOL score was more impaired (105.16 ± 23.8) in females than males (98.37 ± 26.8), It was also more impaired in patients living in rural areas (102.83 ± 25.3) than patients living in urban areas (100.79 ±25.8) , It was also more impaired in married patients ( 104.48 ±24.0 ), substance abuse (113) , skilled workers (109.4 ± 27.08) and illiterate patients (105.30 ± 23.19) .
HRQOL was better in patients who achieved EVR at week 12 (100.62 ± 25.93) compared with (107.78 ± 22.64) for non-responders but with insignificant p-value.
Depression:
Depression was assessed by using Beck depression Inventory Scale. It was noted that combined Pegylated Interferon & Ribavirin had significant effect on patients receiving therapy. Before starting treatment with pegylated INF & Ribavirin, 33 patients (24.8%) suffered from depression of whom 26 patients (19.5%) had mild depression and 7 patients (5.3%) had moderate depression. At the 4th week, the number increased to 75 patients (56.4%) with significant p-value <0.001, of whom 37 patients (27.8%) had mild depression, 32 patients (24.1%) had moderate depression and 6 patients (4.5%) had severe depression. At the 12th week, the number of patients increased to 82 (61.7%) with significant p-value <0.001, of whom 61 patients (45.9%) had mild depression and 21 patients (15.8%) had moderate depression.
At week 12: the Beck Inventory Scale was more impaired (12.00 ± 3.49) in patients who had Peg-IFN dose reduction compared to (11.51 ± 2.29) in patients with no IFN dose reduction. Also the Beck Inventory Scale was more impaired in patients who had Ribavirin dose reduction (11.68 ± 4.45) compared to (11.50 ± 4.14) in patients with no Ribavirin dose reduction but with insignificant p-value.
At week 12: Incidence of depression was more frequent in females, patients living in urban areas, married patients, patients with substance abuse, skilled workers and illiterate patients. (Beck Inventory Scale) was more impaired (11.89 ± 4.25) in females than males (11.26 ± 4.19), It was also more impaired in patients living in urban areas (11.63 ± 4.31) than patients living in rural areas (11.44 ± 4.11), It was also more impaired in married patients (12.01 ±4.26), substance abuse (14), skilled workers
(13.24 ± 4.25) and illiterate patients (11.94 ± 4.12).
Also incidence of depression was more common in non responders at week 12 (BDI= 13.11 ± 4.92) compared to (BDI=11.31 ± 4.07) in patient who showed EVR.