Skimming through to see what they think, and found this:
On the other hand, patients undergoing interferon therapy the appearance of depression correlates with the depletion of serotonin in platelets, possibly due to the effectiveness of antidepressants that inhibit serotonin reuptake
Claims that medicine never took seriously the chemical imbalance BS are really impressive BS.
Now they seem to think that "central fatigue" is just lack of motivation:
Chronic fatigue is an important clinical finding in patients with chronic hepatitis virus infection. Fatigue, according to foreign researchers, has 2 main types – central and peripheral, which can occur both in combination and separately (Golabi et al., 2017). Central fatigue is characterized by a lack of self-motivation and can manifest itself in both physical and mental activity
Caused by inactivity perpetuated by lack of motivation:
A recent content analysis revealed that the overall level of cognitive impairment and chronic fatigue syndrome in chronic HCV-infection had a significant negative correlation with age. Consequently, emotional and psychosocial problems associated with fatigue may be more common in patients with chronic viral hepatitis than physical problems (Jang et al., 2018b). Chronic fatigue is also very common in the terminal stage of liver disease, recent studies have shown its connection with physical activity in patients with cirrhosis of the liver, so when conducting a 6-minute walking test in patients, its indicators showed low and a high degree of shortness of breath was found, which were associated with chronic fatigue syndrome (Ahboucha et al., 2008)
I doubt this very much, the first half anyway:
Chronic fatigue syndrome is also present in a significant number of patients after liver transplantation (21.5%), and almost half of patients suffer from severe fatigue (45.0%)
And the outcome, terrible quality of life, can be interpreted as its cause, because why not:
In patients with liver cirrhosis, chronic fatigue syndrome is a common complaint and can be considered as a debilitating symptom that negatively affects the quality of life, and also has a strong correlation with depressive symptoms and quality of life
Low quality of life correlates with low quality of life. Got it, champ. Genius work.
See, it's not the symptoms, it's the reaction to the symptoms:
Patients with chronic viral hepatitis are characterized by the dominance of negative emotions, communication difficulties, a high degree of asthenization, difficulties in obtaining psychological help and social support (Aktuğ Demir et al., 2013; Yeoh et al., 2018). In patients with chronic viral hepatitis, depression is a possible reaction to increased psychosocial stress, to the presence of physical symptoms of progression of chronic viral hepatitis, or to existing concomitant diseases
Just as they wrote about RA patients before breakthroughs. And about all chronic illnesses. Just the same nasty bigotry and looking down at people suffering because they decided we brought this on ourselves, or whatever.
All followed by lots of the usual speculation about anxiety, stress and all the BPS nonsense and cinematic universe tropes. Basically, everyone is bad at this stuff everywhere. They have lots of theories, but no evidence.
Frankly, this sentence in the conclusion would have done just as well replacing the whole paper:
The difficulty of diagnosing cognitive impairment in chronic viral hepatitis is due to the fact that the currently used wide range of neuropsychological tests does not fully reflect the degree and features of cognitive dysfunction in this category of patients.
When you don't have the tools to measure something, you're not doing science. So get to work at building the damn tools and quit speculating wildly, it helps no one and only seems to confuse everyone, especially those trying to twist traditional claims with a complete lack of evidence.
