Renal Transplantation: Psychiatric Aspects and Interventions

Abstract

This is a report on the clinical experience in consultation‐liaison psychiatric service for patients with end‐stage renal disease undergoing renal transplantation. Among a total of 30 patients (23 men and 7 women) 13 (43%) developed psychiatric disturbances: depressive state, 8; anxious‐irritable state, 5; and delirious state, 1 (One patient had both depressive and delirious states). Five patients got depressed following the episodes of a rejection reaction. Three of them had a graftectomy which exacerbated their depressions. The occurrence of rejection reaction was thought to be a major precipitating factor. Four patients became anxious‐irritable within a week following transplantation. Patient's intolerance to stressors seemed more responsible for the anxious‐irritable state than stressors per se. Steroid medications were thought to be a predisposing, not a causal, factor to psychiatric disturbances in transplant patients. In the 21 patients who were assessed preoperatively and who had no rejection reactions, the Basic Rorschach Score of less than – 20 was a predictor of posrtransplant psychiatric disturbances. Psychiatric interventions were done for the 13 mentally ill patients in collaboration with the surgeons in charge and ward nurses. For the patients with the anxious‐irritable state, listening, reassurance, and anxiolytics (sometimes with additional antipsychotics) were effective. For those who had a depressive state and who became uncooperative, “conjoint” sessions with the patients and their family members (e.g. spouses) were of therapeutic use.

Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies

“…We could not include 12 studies in quantitative analyses because insufficient data to calculate point prevalence were provided. [21][22][23][24][25][26][27][28][29][30][31][32] Therefore, we included 249 populations in 216 studies comprising 55,982 participants in the meta-analyses (Supplementary Table S1 online).…”

Handbook of Consultation-Liaison Psychiatry

“…Posttransplantation depression can be precipitated by immunosuppressant medications, including steroids (Levy, 1994), by graft rejection (Iwashige et al, 1990), and by psychodynamic factors (Fukunishi et al, 2001). Transplanted patients are also vulnerable to anxiety caused by medications as well as by the chronic threat of rejection and organ failure.…”

The changes in quality of life during the first year after the renal transplantation: The influence of physical activity and nutrition

“…Watanabe and Hiraga [12] noticed that there are more than 20% patients suffering from different psychiatric disorders although these are not serious symptoms. Iwashige et al [13] registered psychological disorders in approximately 43% patients in the group of renal transplant patients. Such psychological disorders include depressive episodes, anxiety and delirium.…”

“…Such psychological disorders include depressive episodes, anxiety and delirium. The moment initializing depressive episode in renal transplant patient is frequently when the draft is rejected [13]. During the first year after the renal transplantation, more than one half of the patients suffer from anxiety, suicidal rate is higher and the most common psychiatric complication is delirium as well as organic mood syndrome [12].…”