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Reluctance to accept life-saving treatment
International Journal of Psychiatry in Medicine
|January 1, 1975
Summary
A young man with end-stage kidney disease rejected hemodialysis due to psychological conflicts. Addressing his need for independence through home dialysis or transplantation may improve treatment adherence.
Area of Science:
- Nephrology
- Psychiatry
- Psychology
Background:
- End-stage kidney disease (ESKD) necessitates renal replacement therapy, often hemodialysis.
- Patient's history includes childhood trauma and unresolved grief impacting treatment acceptance.
Observation:
- A 23-year-old male patient with ESKD exhibits significant conflicts regarding maintenance hemodialysis.
- He displays pseudoindependent behavior and hypermasculinity, rejecting the passive role of a hemodialysis patient.
- These behaviors are linked to unconscious doubts about manliness and unresolved issues surrounding his father's suicide.
Findings:
- Rejection of hemodialysis can represent a conscious or unconscious suicide attempt, influenced by psycho-social factors and guilt.
- The patient's resistance to hemodialysis is rooted in a need to assert independence and avoid perceived emasculation.
Implications:
- Treatment strategies should prioritize patient autonomy and independence.
- Home dialysis or renal transplantation may be more suitable than center-based hemodialysis.
- Psychiatric or liaison physician support is crucial to explore grief and psycho-social factors impacting treatment adherence.