Evaluation of psychiatric issues in renal transplant setting

Factors Affecting Anxiety of Kidney Transplant Recipients According to Donor Type: A Descriptive Study

PURPOSE

High anxiety among kidney transplant recipients has negative psychosocial consequences for health quality. This study aims to determine the risk factors that affect levels of anxiety in recipients of kidney transplants according to living and deceased donor types.

DESIGN

The study was conducted using a descriptive correlational research method.

METHODS

The study conducted research with 330 kidney transplant recipients (from 261 live and 69 cadaver donors) who agreed to participate between February and July 2019. Participants completed the State-Trait Anxiety Inventory, which assesses state and trait anxiety.

FINDINGS

Participants had low state anxiety and moderate trait anxiety scores. A statistically significant, positive, moderate correlation was found between state anxiety scale and trait anxiety scale mean scores of recipients of kidney transplants from both living and deceased donors. According to a regression analysis of trait anxiety scores of transplant recipients from living donors, positive independent risk factors for anxiety include kidney transplant recipients with a low income, receiving kidneys from male donors, drug noncompliance, sleep disorders, and mental problems.

CONCLUSIONS

Both kidney transplant recipients from living and deceased donors had low state anxiety and moderate trait anxiety. Nurses should develop effective intervention strategies that continue throughout life to reduce the anxiety of kidney transplant recipients.

Rare Mental Health Disorders Affecting Urologic Care: A Comprehensive Review

Management of mental health illnesses and needs are important in fostering psychosocial support, interprofessional coordination, and greater adherence to treatment protocols in the field of urology. This can be especially true for mental health conditions that may greatly impact the presentation of a patient in the healthcare setting with urologic symptoms. This review describes the history, epidemiology, pathophysiology, clinical presentation, and treatment of somatic symptom disorder, illness anxiety disorder, compulsive sexual behavior/hypersexuality, factitious disorder, malingering symptoms, and conversion disorder in the realm of urology. Given the newly updated psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, there has been a lack of studies reviewing how these illnesses may present in a urology patient encounter. Additionally, as these mental health illnesses may carry a rare incidence compared to other well-known mental health illness such as generalized depression or generalized anxiety disorder, we have found that the lack of provisions and recognition of the diseases can prolong the timeline for diagnosis and lead to an increased cost in both healthcare and quality of life of patients with these mental health illnesses. This review provides awareness on these mental health conditions which may greatly impact patient history and presentation within the field of urology. Additionally, urologic care providers may have an improved understanding of interdisciplinary management of such illnesses and the common symptoms patients may present with such diseases.

Management of the Failing Kidney Transplant: Challenges and Solutions

The kidneys are the most transplanted organs, and the number of failed kidney transplants that require reinstitution of renal replacement therapy in patients is on the increase. Increased mortality has been noted in patients with failed grafts compared with transplant- naïve patients with chronic kidney disease who are treated with dialysis. Issues such as management of immunosuppression, the need for transplant nephrectomy, addressing the increased risk of cardiovascular events, malignancies, and infections are debatable and often based on individual or hospital practices. The optimal timing and modality of renal replacement therapy to be reinitiated are sometimes blurred, with considerable variations among physician practices. Guidelines are therefore needed to appropriately manage this special population of patients with the aim of improving outcomes. Here, our objective was to review the current practices in managing patients with failing kidney transplants so that recommendations can be made based on the available evidence.

Adherencia al tratamiento en infantes con insuficiencia renal crónica: inclusión del psicólogo al equipo interdisciplinario

Resumen La enfermedad renal crónica (ERC) constituye una de las principales causas de mortalidad a nivel mundial. Se calcula que en México existen alrededor de 140.000 pacientes con este padecimiento. El presente trabajo tuvo como objetivo comprender los factores que facilitan e inhiben la adherencia al tratamiento de los pacientes pediátricos con ERC, dando énfasis en el abordaje interdisciplinario y en la inclusión del/la psicólogo/a para favorecer la atención integral de los pacientes. Se realizó un estudio descriptivo de tipo cualitativo, por medio de la técnica de entrevista con análisis por categorías. Participaron cuatro profesionales: un médico, una enfermera, una nutrióloga y una psicóloga del Hospital Infantil y de la Clínica de Hemodiálisis Galeno en Morelia, Michoacán, México. Los resultados mostraron la importancia del acompañamiento psicológico al paciente para la aceptación del diagnóstico, el manejo emocional, la adherencia al tratamiento y apoyo social, en especial con su cuidador/a primario. Finalmente, se propone un modelo de atención al paciente con ERC desde un enfoque interdisciplinario.

Quality of life in a sample of Egyptian renal transplant recipients

Background

Poor quality of life has been reported after renal transplantation.

So, we aimed to identify the quality of life and its demographic and clinical correlates among Egyptian renal transplant recipients.

A cross-sectional observational study of 230 post-renal transplantation recipients (PRTRs) who were recruited from Ain Shams University Specialized Hospital and Nasser Institute nephrology clinics. All cases were subjected to a designed questionnaire for PRTRs, the semi-structured questionnaire for renal transplant recipients and the Arabic version of the World Health Organization Quality of Life Questionnaire (WHOQOL-100).

Results

All the PRTRs had unsatisfactory social quality of life (QoL) while 97.8% had unsatisfactory overall QoL; moreover, 92.6% were not satisfied as regards environmental and independence QoL. Psychological dissatisfaction was met in 75.7% of all subjects, whereas the least dissatisfaction rate was the spiritual QoL (15.2%). Younger age groups were the most who complained of unsatisfactory quality of life in all domains except the spiritual QoL. All domains of QoL were found not statistically associated with gender, marital status, or social class. Subjects who received higher education had better psychological and independence QoL. The overall QoL and physical QoL were found to be correlated only with age. The psychological and independence QoL were positively correlated with age, sex, educational level, and occupation while the environmental QL was found to be positively correlated with occupation.

Conclusion

The prevalence of unsatisfactory quality of life is quite high among PRTRs. Our findings pointed to the need of recognizing quality of life among renal transplant recipients, and we suggest that mental health professionals should be included in the multidisciplinary team.

Psychopharmacology in transplantation medicine

Organ transplantation has become a well-established treatment option in patients with end-stage organ diseases. Although quality of life has markedly improved, psychiatric disorders before and after transplantation are more frequent compared to the general population. Psychopharmacological treatment is recommended for almost all mental disorders according to current guidelines, but may pose particular problems in organ transplant patients. Changes in the metabolism and elimination of drugs during organ insufficiency, drug interactions, and overlapping side effects between psychopharmacological and immunosuppressive drugs are challenging problems in clinical management. Furthermore, questions frequently arise concerning the use of psychopharmacological treatment options for sleeping and anxiety disorders. This article reviews psychopharmacology in organ transplant patients, with particular attention to frequent psychiatric disorders observed in the disease course of end-stage organ diseases.