From the Guidelines
A liver function test (LFT) panel can indirectly reveal information about mental health and mood changes by detecting liver damage or disease that may contribute to cognitive symptoms or mood alterations, as seen in conditions like hepatic encephalopathy 1.
Liver Function and Mental Health
A liver panel primarily assesses liver function and can detect liver damage or disease. While it's not designed to diagnose mental health conditions, abnormal liver function can sometimes contribute to mood changes or cognitive symptoms. For example:
- Elevated ammonia levels due to liver dysfunction can cause confusion or altered mental status.
- Severe liver disease can lead to hepatic encephalopathy, which may present with personality changes, confusion, or even coma, as noted in the 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases 1.
- Certain liver conditions, such as Wilson's disease, can affect hormone metabolism and potentially influence mood, with psychiatric symptoms being common and sometimes preceding neurologic or hepatic signs and symptoms 1.
- Alcohol-related liver damage may be associated with mood disorders, as alcohol abuse often co-occurs with mental health issues.
Importance of Further Evaluation
If a liver panel shows abnormalities and a patient is experiencing mood changes, further evaluation is necessary to determine any potential connection, as the liver panel alone is not a diagnostic tool for mental health conditions. Mental health symptoms should be assessed separately through psychiatric evaluation and specific mental health screenings. The liver panel can provide context for overall health status that may indirectly affect mood and cognition, as discussed in the management of major complications of cirrhosis beyond guidelines 1.
Recent Guidelines and Recommendations
Recent studies, such as the 2021 management of the major complications of cirrhosis: beyond guidelines, highlight the importance of screening for mild hepatic encephalopathy, which can affect quality of life, social and family relations, earning capacity, and the ability to drive 1. The use of bedside tools, such as the animal naming test, can facilitate the screening process. Attributing neuropsychiatric abnormalities to liver complications requires careful evaluation and differential diagnosis, considering the potential impact of liver disease on mental health and mood changes.
From the Research
Liver Function Test (LFT) Panel and Mental Health
A liver function test (LFT) panel can reveal information about the liver's condition, which may be related to mental health and mood changes. The following points highlight the relationship between liver disease, mental health, and mood changes:
- Liver disease can have a significant impact on mental health, with studies showing that patients with liver disease are more likely to experience depression and anxiety 2, 3, 4.
- Mental health issues, such as depression and anxiety, can affect the quality of life (QOL) of patients with liver disease, independent of the degree of liver disease severity 3, 4.
- The severity of liver disease, particularly cirrhosis, can also affect physical QOL, but not necessarily mental QOL 3.
- Pain is a common symptom in patients with cirrhosis, and it is often associated with anxiety and depression, which can further impair QOL 4.
- Certain medications used to treat mental health conditions, such as clozapine and paliperidone, can increase the risk of hepatic steatosis (fatty liver disease) 5.
Relationship Between Liver Disease and Mental Health
The relationship between liver disease and mental health is complex, with both conditions influencing each other:
- Liver disease can lead to changes in mental status, including depression, anxiety, and cognitive impairment 2, 6, 3.
- Mental health issues, such as personality disorders, can increase the risk of developing liver disease, particularly non-alcoholic fatty liver disease (NAFLD) 6.
- The presence of liver disease can also affect the treatment of mental health conditions, with some medications requiring dose adjustments or monitoring due to potential liver toxicity 5.
Screening for Liver Disease in Mental Health Patients
Given the high prevalence of liver disease in patients with serious mental illness, screening for liver disease should be considered as part of standard physical health assessments:
- Non-invasive diagnostic tools, such as vibration-controlled transient elastography (VCTE), can be used to assess liver disease severity and detect advanced liver disease 5.
- Early detection and treatment of liver disease can improve QOL and reduce the risk of complications in patients with mental health conditions 2, 3, 4.