End-stage kidney dialysis patients psychological problems
According to reports, end-stage renal disease (ESRD) this is estimated that the total number of patients in China ERSD about 220,000 (in 1990 China’s statistics), the larger the number. Now is the main blood purification treatment (hemodialysis, peritoneal dialysis) and kidney transplantation, patients can prolong the survival period, improve the patient’s quality of life. As we all know, dialysis patients are correct some physiological indicators for the purpose of a traumatic is a lifelong treatment. Domestic and foreign studies indicate that a dialysis patient’s psychological state of ESRD patients have a significant impact on the prognosis. This paper summarizes the dialysis with end-stage renal disease were related to psychological problems and related factors on the diagnosis and treatment of its research progress.
I, and dialysis - related psychological problems Kaplan, and others reported 53% of dialysis patients have depression, anxiety reactions [2]. Kimmel, and other people think that depression is when most ESRD patients hemodialysis see psychological problems. The mortality rate of patients with hemodialysis related [3]. Farmer, and so that 27 percent of hemodialysis patients have suicidal thoughts [4]. Clinical manifestations of depression are four major characteristics: (1) depressive mood, pessimistic, lost sense of pleasure; (2) self-evaluation decline ERA, useless flu. Since serious crimes, initiation suicide Nian (3) sleep disturbance, decreased appetite, decreased libido; (4) social withdrawal, decreased activity. Because depression affect the outcome of ESRD patients hemodialysis, Kimmel infer the treatment of depression hemodialysis patients may improve the results [3].
Anxiety is a common psychological reaction, especially the first dialysis patients on dialysis are often the success or failure of performance concerns, as well as the physical side effects of dialysis fear [4], in 23 cases ambulatory peritoneal dialysis children with persistent Separation Anxiety obstacles incidence of control than healthy children significantly increased [5]. Zhou Angel in 1993 reported larger series of ESRD dialysis patients the total incidence of depression and anxiety for 85.11%, significantly higher than the same period in hospital surgical patients, depression rate was 74.47 percent, and anxiety for 65.96 percent, after the dialysis fell to 57.45%, of which depression was 53.1 percent, anxiety is reduced to 12.77%, the changes more obvious that dialysis not only physiological indicators improved, but can lead to psychological conditions improved [6].
Dialysis patients neutral psychological barrier rather common, Levy reported that 70% of the middle-aged male impotence occur [7]. Emotional response, cognitive distortion of the role of families and sick after the change is the major psychological impact factors, drugs and hormone secretion disorder is possible reasons [8].
0.2% of patients in dialysis encephalopathy, mostly found in dialysis 2 years or more patients, showed language barriers, stuttering, memory diminish, Flapping-Wing-like tremor and body tremor, and the characteristic EEG changes in disease progression soon, the mortality rate as high as 29% [9].
Second, dialysis patients with ESRD anxiety and depression in response to the psychological factors that biological research Rodin ESRD depressive symptoms is usually a reaction, but serious, lasting depressive symptoms not common. If so, it suggested that a clinical intervention necessary. More serious diseases, in the past history of depression and lack of social support is a serious depression risk factors [10]. 1992 Alarcom such study found that renal failure patients for the rare complication of hyperthyroidism secondary (SHPT), the organ of anxiety can be caused by reaction [11]. While Driessen in the 1995 study of chronic renal failure secondary hyperparathyroidism group and the relationship between depressive symptoms. 59 cases of chronic renal failure and 16 cases of renal failure patients in the control depression checked parathyroid hormone (PTH), calcium, phosphorus and psychiatric symptoms and found that chronic renal failure patients with cognitive impairment than PTH levels of depression patients , suggesting that the cognitive impairment SHPT Additional features for the depressive symptoms occurred in the group may play an important role [12]. Everett - KD dialysis patients with depression reported interval directly related to excessive weight gain [13]. Zhou Angel report depressive illness and IgM have some relevance, suggesting that immune function and emotional activities linked to a certain extent [6], these aspects of the study on the treatment of renal failure patients is extremely important, and the psychological problems with resolve to reduce dialysis disease (such as dialysis interval excess of the important reasons for the growth in the hemodialysis symptomatic hypotension, etc.) very important.
Third, physician-patient relationship in the treatment of ESRD patients dialysis According to the significance of N. Clols eight years of clinical observation found that the health care system is renal failure patients have an important psychological barrier source of stress, if these problems can pay sufficient attention to the situation will be quite different.
Health care workers guidance and help renal failure patients daily diet and reasonable arrangement, as well as the importance of self-care. Dialysis patients in the course of treatment of various economic potential serious complications, health care workers if prior notification to patients in an appropriate manner, and discuss with the patient when there are problems in how active and effective treatment so that things psychologically prepared. The treatment and rehabilitation of patients will have a positive impact.
Medical staff should be highly sympathetic sense of responsibility, sensitivity and a high degree of professional ethics of, but in our health care system, the common problem is not well understood patients, the lack of in-depth contact, and sharp insight to discover patients practical difficulties and psychological reaction, but also health care professionals often lack the means to solve the psychological problems, psychological treatment experience, the results tremendous pressure on the patient’s mental, psychological barriers timely identification and treatment, an increase of treatment difficult.
Solving this problem should first improve the quality of professional health care workers, other health care professionals should also encourage patients to play active in the development of the inherent potential of the patient to combat disease and adverse emotional, health care professionals and patients to establish a good doctor-patient relationship, mutual to help achieve treatment goals.
Fourth, in addition to treatment of the doctor-patient relationship good, supportive psychotherapy, medication is necessary, the application of ESRD patients dialysis treatment, including psychological support and to listen, to convey and disperse patients bad mood and encourage patients to face reality, to the proper interpretation to eliminate doubts, the light of their own conditions, select appropriate activities, establish a positive attitude towards life. Over the past decade antidepressants has achieved new progress, since 1988 fluoxetine (Fluoxetin), trade names: fluoxetine (Prozac) Clinical application soon after, a group of new antidepressants known as “selective 5 - serotonin reuptake inhibitors (SSRIs) “come out one after another, with the exception of fluoxetine, there paroxetine (Paroxetine), sertraline (Sertraline), trade names : Lok Fu Yu (Zoloft), the above three drugs in the domestic application of equal efficacy and tricyclic, safe, less adverse reaction, more ready to accept patients [14]. 1996 Levy of depression associated with the renal failure patients taking fluoxetine pharmacokinetics and effects were studied to normal renal function of depression patients as the control group, 20 mg / d, the treatment eight weeks, the study confirmed that fluoride West Ting struck in the pharmacokinetics and the major metabolite basic agreement, the same effect [15].
Domestic and foreign studies have shown that dialysis patients with ESRD incidence of psychological problems was significantly higher than the average patient to the most common depression and anxiety, depression was considered ESRD patients died of an independent factors affecting dialysis patients immunization, nutrition and Compliance of, in particular need of attention aroused. The severity of the disease, previous history of depression, lack of social support, depression SHPT occurred, it is leading to the risk factors. ESRD patients in dialysis treatment in doctor-patient relationship has important significance. Supportive psychotherapy and SSRIs in resolving the ESRD patient’s psychological problems such as depression and anxiety in clinical value has aroused the attention and started a preliminary study.
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