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Renal transplantation: psychiatric aspects and interventions
T Iwashige1, K Inoue, T Nakajima
1Department of Psychiatry, Kyoto Prefectural University of Medicine, Japan.
The Japanese Journal of Psychiatry and Neurology
|March 1, 1990
Summary
Psychiatric disturbances affect 43% of end-stage renal disease patients post-transplant, with rejection reactions and stress intolerance as key factors. Early Rorschach scores may predict these issues.
Area of Science:
- Nephrology
- Psychiatry
- Transplantation Medicine
Background:
- End-stage renal disease (ESRD) patients undergoing renal transplantation face significant psychological challenges.
- Consultation-liaison psychiatry services are crucial for managing these complex cases.
Observation:
- A study of 30 ESRD patients revealed 43% developed psychiatric disturbances post-transplantation.
- Common disturbances included depressive state (8 patients), anxious-irritable state (5 patients), and delirious state (1 patient).
- Rejection reactions were identified as a major precipitating factor for depression, with graftectomy exacerbating symptoms in three patients.
Findings:
- Patient intolerance to stressors, rather than stressors themselves, contributed to anxious-irritable states.
- Steroid medications were considered predisposing, not causal, factors for psychiatric issues.
- A preoperative Basic Rorschach Score below -20 predicted post-transplant psychiatric disturbances in patients without rejection reactions.
Implications:
- Psychiatric interventions, including medication and conjoint therapy, were effective in managing post-transplant psychological distress.
- Collaboration between psychiatric teams, surgeons, and nurses is vital for optimal patient care.
- Early identification of at-risk patients through preoperative assessments can guide proactive psychiatric support.