Anxiety disorders and pediatric continuous ambulatory peritoneal dialysis

Mental health and social-emotional functioning in children and adolescents with chronic kidney disease

For children and young adults, living with chronic kidney disease (CKD) poses physical, mental, and social challenges. The mental health functioning of children and adolescents with CKD plays an important role in the medical, educational, vocational, and quality of life outcomes, yet receives little systematic attention in the busy pediatric nephrology clinic. This article will provide an overview of the prevalence of mental illness and symptoms in children and young adults with CKD, strategies to assess for dysfunction, and the long-term outcomes associated with impaired functioning. While there is a relative dearth of literature regarding evidence-based interventions in this population to improve mental health functioning, we provide "best practice" strategies based on the available literature to address emotional and/or behavioral challenges once they are identified. More research is needed to define appropriate interventions to alleviate mental health issues and social-emotional distress, and this review of the literature will serve to provide directions for future research.

Psychosocial considerations and recommendations for care of pediatric patients on dialysis

Dialysis treatment has evolved to enable children to live longer and transition to adulthood. Thus, the focus of care shifts to a consideration of pediatric patients' quality of life and psychosocial functioning across childhood, adolescence, and young adulthood. Despite well-documented concerns in various domains (including depression/anxiety, self-esteem and social functioning, behavior problems, and academic and cognitive functioning), limited literature exists regarding psychosocial guidelines for children and adolescents undergoing dialysis. This article aims to address this gap by providing a review of the pediatric literature examining psychosocial functioning in patients treated with dialysis, as well as recommendations for specific psychosocial concerns. Overall recommendations for care include screening for anxiety and depression, referral to pediatric psychologists for evidence-based intervention, utilization of child life specialists, opportunities to promote social functioning, neuropsychological evaluation and school programming, ongoing support in preparing for transition to adult care, and periodic measure of quality of life. Together, these suggestions promote a holistic approach to patient-centered care by supporting both physical and psychosocial well-being.

Low serum levels of vitamin D are associated with anxiety in children and adolescents with dialysis

Anxiety is a frequent and serious complication of children and adolescents receiving dialysis. Low serum vitamin D levels have been associated with anxiety in non-pediatric patients. This study sought to examine the possible association between serum vitamin D levels and the presence of anxiety in children and adolescents with dialysis in China. A total of 156 pediatric patients who were on hemodialysis or peritoneal dialysis and 100 healthy controls were included in the current study. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured by using a competitive protein-binding assay. Anxiety was assessed by using the Chinese version of the Screen for Child Anxiety Related Emotional Disorders (SCARED, = 25 as cutoff). Among 156 patients, 110 had a current anxiety (70.5%) and 46 did not (29.5%). Serum levels of 25(OH)D were significantly lower in patients with anxiety than in normal controls (19.4 ± 10.3 vs. 38.6 ± 15.5 ng/ml, P < 0.001). Serum 25(OH)D levels (≤15.0 ng/ml) were independently associated with the existent of anxiety in children and adolescents receiving dialysis (OR 4.650, 95% CI 1.663-13.001, P = 0.003). Our research demonstrates that low serum levels of vitamin D are independently associated with anxiety among children and adolescents on dialysis, which needs to be confirmed in future experimental and clinical studies.

Kidney transplantation and liaison psychiatry, part II: A case of dissociative identity disorder

The authors examined the case of an adolescent patient with dissociative identity disorder secondary to psychological shock of a transplant rejection response. Psychiatric symptoms consisted of three components: visual hallucinations and delusions as a psychological defense against the anxiety of a transplant rejection; appearance of three personalities including proper self, the dead child (donor), and a prophet with strong predicting power; and a twilight state. These psychiatric symptoms may have been related to two psychological factors: immature personality characteristics formed during hemodialysis, and post-traumatic stress caused by a chronic rejection reaction from the patient's first transplant.

Severity of alexithymia is related to psychosocial factors in patients with peritoneal dialysis

We examined the relationship between alexithymia and psychosocial factors in 72 peritoneal dialysis patients. The 72 patients had significantly higher scores on alexithymia and anxiety than did 73 healthy volunteers. The alexithymia scores were significantly and positively correlated with anxiety scores, suggesting that alexithymia may be related to anxiety derived from the stress associated with dialysis therapy. After 3 yr. of follow-up consultations, patients were still showing higher scores on alexithymia and anxiety; however, alexithymia scores were not correlated with anxiety scores but rather were significantly associated with poor social support. Alexithymic characteristics may be related to psychosocial factors such as the availability of social support.

School adjustment of children with end-stage renal disease

We examined adjustment to school of children with end-stage renal disease (ESRD) and the psychological condition of their mothers; 30 children on continuous ambulatory peritoneal dialysis (CAPD), 35 children with a transplant and 33 healthy children were studied. A factorial ANOVA statistic found that the mean scores for non-academic problems (psychological factors) differed significantly across the three groups, being highest in CAPD children and lowest in healthy children. No significant differences between CAPD and transplant children were found for school maladjustment with academic problems, although the prevalence differed significantly across the groups, being highest in transplant children and lowest in healthy children. The mothers of children with ESRD were prone to feel various anxieties and dependency.

Psychiatric problems of pediatric end-stage renal failure

Our study compared 53 children with end-stage renal disease (26 children on continuous ambulatory peritoneal dialysis and 27 children with kidney transplants) to a matched sample of 27 healthy children. Seventeen of the children on dialysis (65.4%) exhibited separation anxiety disorder, which was associated with the family psychological environment. After receiving kidney transplantation, school maladjustment continued, and adjustment disorder was seen in eight children (29.6%). The adjustment disorder was related to poor relationships with peers at school.