Psychiatric aspects of chronic renal disease

Life-extending treatment for end-stage renal disease is now accepted standard procedure when feasible. The spectrum of treatable patients is expanding to include many with serious emotional problems. This expansion places an added burden on staff and patient alike, as the stresses produced often cause significiant dysphoria even in the patient who is well integrated emotionally. Psychiatric morbidity must be expected and managed as well as circumstacnes will allow. As in most other human endeavors, patients who are likely to be successful are the fortunate few who can adapt to difficult and chronic stresses, undergo positive emotional experiences, and have a supportive family, satisfying work, solid identity, and comfortable self-esteem--in short, those with good mental health. The discussion speculates on personality or life-experience variables that might have prognostic usefulness.