Increased self-report of obsessive-compulsive behaviors among hemodialysis patients: a case-control study

Patients with end-stage renal insufficiency undergoing hemodialysis show important psychiatric morbidity, particularly increased depression and anxiety. Obsessive-compulsive symptoms, however, are much less frequently investigated. The purpose of the present study was thus to assess obsessive-compulsive symptoms in hemodialysis patients.

Patients treated at an outpatient hospital hemodialysis unit (July 2007) were compared with controls on scores on the Maudsley Obsessional-Compulsive Inventory (MOCI) and its checking, cleaning, slowness, and doubting components as well as on measures of emotional (Beck Depression Inventory-Fast Screen), anxiety (Beck Anxiety Inventory), and cognitive (Trail Making Test) status. Student t tests, analyses of covariance, or nonparametric tests were used. Correlations were applied between behavioral outcomes and demographic, clinical, and laboratory data of patients.

Patients showed more obsessive traits than controls on the MOCI total score (P < .001) and on the checking, cleaning, and doubting subscales. Significant differences between groups occurred also in Beck Depression and Anxiety Inventories (P ≤ .001). The MOCI total score did not correlate with marital status, education level, duration of hemodialysis, or the other psychological instrument scores in patients. By contrast, the MOCI total score was associated with the level of creatinine, and it showed an inverse correlation with the urea reduction ratio in patients (P < .05).

Obsessive-compulsive symptoms may constitute an important aspect of the psychiatric profile of patients undergoing hemodialysis. Potential interpretation involves disease- and treatment-associated factors or adaptive responses to emergence of otherwise uncontrollable stress.