Hemodialysis 에 관한 정신의학적 연구

PSYCHIATRIC ASPECTS OF HEMODIALYSIS

A clinical study was conducted on the psychiatric problems manifested by 21 chronic renal failure patients on maintenance hemodialysis at Yonsei Medical Center. Structred interviews with the patients and family members were done at least twice on each patient and Zung’ s self-rating depression scale, Hamilton’ s anxiety and depression scales were administered. The data obtained were compared with those of both normal control and neurotic patients group. The results indiated that patients on the hemodi ialysis have confronted with serious personal, familial and socioeconomic stresses and they suffered from marked psychiatric symptoms such as depression, pessimistic idea, guilty feeling, psychomotor retardation, rejected feeling, increased dependency, irritability and insomnia. But they showed tendency to minimize or deny their problems and complaints, as reflected in the self-rating depression scale. Denial was considered to be the mian defense mechanism against chronic stress associated with the procedure. And the depression of those patients was characterized by the fact that female patients showed higher scores than males, and by the fact that the longer the duration of hemodialysis, the more severe the degree of depression and that comparing to neurotic patients, they showed higher scores in decreased libido, dissatisfaction and suicidal rumination in Zung’ s SDS. Also two case histories of acute psychotic episode were presented; they were characterized by relatively short-term progress of about 7 days with good prognosis and bizarre symptoms as mask like dull facial expression and symbolic expression of suicide and of conflit associated with death. Lastly, the possible roles of psychiatry for patients on the hemodialysis were discussed.