Psychiatric considerations in the primary medical care of the patient with renal failure.
The adequate primary care of patients with renal failure, from the choice of the modality of treatment down to the everyday answering of questions of patients, relatives, and staff, requires a knowledge of the major psychological stresses of the illness and the psychiatric complications resulting from these stresses and their treatment. Among the major stresses of dialysis are the procedure itself, the overall medical treatment which includes medications and diet, and dependency-independence issues arising from the unique and almost abject dependency of patients on a machine, a procedure, and a group of medical professionals. As a result of these physical and psychological stresses, the disorders seen include delirium, depression, anxiety, suicide, uncooperative behavior, sexual dysfunctions, and psychosis. In their treatment, one should first consider what prophylactic steps should be taken to avoid their occurrence. It is best that a behaviorally trained professional be involved in the initial evaluation of all prospective patients. Ideally this should be a consultation-liaison psychiatrist. Such involvement may help in the selection of a modality of treatment best suited for the psychosocial background of the patient and help identify those most susceptible to psychiatric symptoms and disorders. Patients should be told of the possibility of complications such as sexual dysfunctions and, in the case of dialysis patients, that they may at some point in the course of their treatment consider voluntary withdrawal from it. Medications have an important role in the treatment of anxiety, insomnia, depression, psychosis, and sexual dysfunctions. Concerning the latter, behavioral techniques of Masters and Johnson have been found to be useful. Talking therapies seem to be of value for only to a limited number of motivated patients.
Department of Psychiatry and Medicine, State University of New York Health Science Center at Brooklyn, USA. Nephropsyc@aol.com
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Levy
D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D001523:Mental Disorders / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D011320:Primary Health Care; D017582:Renal Replacement Therapy / Q000009:adverse effects