This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Hepatic encephalopathy & hepatic failure, Subject name: Medicine
Earliest manifestation in hepatic encephalopathy is? 
Select and explain. 
A. Asterixis, B. Alternate constriction and dilated pupil, C. Constructional apraxia, D. Psychiatric abnormalities
D: Psychiatric abnormalities
Answer: D: Psychiatric abnormalities 
Explanation: Earliest manifestation in hepatic encephalopathy is Psychiatric abnormalities.