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Renal Transplantation: Psychiatric Aspects and Interventions
Author(s) -
Iwashige Tatsuya,
Inoue Kazuomi,
Nakajima Teruo
Publication year - 1990
Publication title -
psychiatry and clinical neurosciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 74
eISSN - 1440-1819
pISSN - 1323-1316
DOI - 10.1111/j.1440-1819.1990.tb00436.x
Subject(s) - psychiatry , transplantation , psychological intervention , stressor , anxiety , medicine , depression (economics) , psychology , clinical psychology , economics , macroeconomics
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.