The association between diseases of the liver and psychiatric disturbance has been a neglected area of clinical research despite the observations of ancient Greek physicians, notably Galen and Hippocrates, who had no doubt of the importance of the liver's influence on the mind. The pattern of psychiatric symptoms of liver disease is greatly influenced by whether the liver disease is acute or chronic in nature. Fatigue has become recognized as being one of the most debilitating symptoms of chronic liver disease. Liver transplantation has transformed the prognosis of patients with end-stage liver disease. Patients with alcoholic liver disease should not be excluded from consideration for transplantation. Their outcome is just as good as that of patients transplanted for non-alcoholic liver disease. Drugs that have a high rate of hepatic clearance are largely cleared during their first passage through the liver, a phenomenon known as the first-pass effect.