Psychological factors associated with severe abuse of the Hemodialysis diet

Thirty-one maintenance hemodialysis patients were observed for a six-month period. Seven of these patients (22.6%) were severe and persistent abusers of the hemodialysis diet. Because there are serious, even lethal, consequences of the sequelae of hemodialysis diet abuse such as fluid overload and/or hyperkalemia, this finding demands explanation. All seven severe abusers were men and, as a group, their current life situation was devoid of typical adult male gratifications. Their developmental histories indicated major difficulties with resolution of dependency/independency conflicts. Statistical analysis of demographic data and extensive psychiatric interviews support this. The author postulates that severe abuse of the hemodialysis diet results in part from the combination of unresolved dependency conflict, unfavorable current environmental circumstances, and a dependency-provoking treatment regimen. Severe abuse of the hemodialysis diet may serve an adaptive function by allowing at least some gratification in one area of the lives of these patients who suffers severe deprivation.

Denial in dialysis patients: relationship to compliance and other variables

Denial has been documented as an important defense mechanism to helping the chronically ill cope with their disease. With respect to a dialysis population, however, the role of denial has been ambiguous. The purpose of this study were 1) to examine the physiological and psychological correlates of denial in a dialysis population and 2)( to examine the relationship between use of denial and compliance to fluid restrictions. Subjects were 46 self- and limited-care dialysis patients. From this subject pool two groups were derived, based upon weight gains between treatments: complies (N=15) and noncompliers(N=16). Both physiological and psychological data were correlated with denial as measured by the Marlow-Crowne Social Desirability Scale. Results indicated that denial is used a great deal in dialysis patients, but there was no difference in denial scores between compliers and noncompliers. For compliers, however, denial was correlated with more adaptive attitudes toward illness. The results have implication for the clinical management of dialysis patients.

Halstead-Reitan Test results in chronic hemodialysis

Neuropsychological functioning of chronic hemodialysis, undialyzed uremic, and medical-psychiatric patients was explored using the Halstead-Reitan Battery. The three groups of 16 patients each did not differ significantly in age, education, verbal intelligence, or degree of affective disturbance. Specific Halstead-Reitan Battery subtest comparisons demonstrated that dialysis patients performed significantly better than uremic patients and were equivalent to medical-psychiatric subjects on tasks of psychomotor problem-solving and spatial ability. Dialysis patients were significantly better than uremic subjects, but impaired relative to the medical-psychiatric patients on a task of flexible thinking. Dialysis patients were impaired relative to medical-psychiatric subjects and equivalent to uremic patients on tasks which required complex analysis, auditory information processing, language capacities, and sensory-perceptual functions.

A liaison fellowship on a hemodialysis unit. A self-funded position

The practice of liaison psychiatry has from its inception been hampered by an inadequate or non-existing funding base. A model is presented for funding an authentic liaison training program, fully supported by consultation-generated revenue. A specific description of the liaison teaching unit is given, which illustrates how the following objectives of the program were successfully met: provision of comprehensive biopsychosocial care, dissemination of psychological skills and knowledge to nonpsychiatrist staff, training of the liaison fellow, and generation of sufficient revenue to offset its costs.

Psychosocial disability during maintenance hemodialysis

Overall psychosocial functioning was assessed in 21 maintenance hemodialysis patients. The Ruesch Social Disability Scale, which provides an overall Social Disability (DS) score as well as subscores for Physical Impairment (PI), Behavioral Impairment (BI), and Social Modifiers (MS), was utilized. A majority of the patients (13) experienced Major Social Disability and the mean DS score of this sample was in the Major Social Disability range (mean = 52.1 +/- 10.9). There were no differences between the mean DS score of men and women. Married patients had DS scores significantly lower than those who were divorced or never married (P less than .05). Patients with more than five years of maintenance hemodialysis had a mean DS score significantly higher than those with less then five years of maintenance hemodialysis (P less than .03). In those patients with more than five years of hemodialysis, the MS scale was significantly elevated (P less than .01) in comparison with their counterparts, whereas the BI and PI scores were not different. The data suggest that serious psychosocial impairment is a common sequela of maintenance hemodialysis, especially for long-term patients and those who are not married. Therapeutic approaches directed toward improved social functioning are indicated.

Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients

This research examined the relative efficacies of three intervention strategies designed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients. The interventions examined included behavioral contracting (with or without the involvement of a family member or friend) and weekly telephone contacts with patients. Compliance was assessed with regard to following dietary restrictions and limiting fluid intake. Data were collected from 116 patients drawn from two outpatient clinics. Within clinics, patients were randomly assigned either to an intervention program or to a control group. The study employed a pretest-posttest control group design. Patients were interviewed before the intervention programs began (T1), after a 6-week intervention period (T2), and 3 months after completion of the intervention period (T3). Results showed that the interventions achieved substantial reductions in patients' serum potassium levels and in weight gains between dialysis treatments between T1 and T2. In general, however, these program effects tapered off to preintervention levels between T2 and T3. The findings thus indicate a need for long-term intervention programs.

Social climate perception and depression of patients and staff in a chronic hemodialysis unit

This socioecological study investigates the relationship of depression and social climate perception of patients (N = 59) and staff N = 18) in a chronic hemodialysis unit. The Beck Depression Inventory (BDI) and Moos Ward Atmosphere Scale (WAS) Form C revised for dialysis are used for measurement. Patients and staff are found to have significantly dissonant perception of the unit. Patients perceive the environment more negatively than the staff. Depressed patients correlate with Low WAS scores (p less than .03) indicating that depression influences social climate perception. Depressed patient BDI items are correlated with WAS items via a series of Pearson correlation coefficients for a perceptual profile. Discussion is made as to the dysfunctional affects of dissonance, depression, staff denial and withdrawal. Further studies on altering the social ecology of dialysis units as a method for reducing depression and staff turnover rates are called for.

Vox clamantis in deserto: do you really mean what you say in Spring?

Probably the most vexing result of the Massachusetts Supreme Judicial Court's [SJC] opinion in the Spring case is that judges, lawyers, and others faced with similar problems in other jurisdictions are likely to read the opinion and commend the Supreme Judicial Court for its efforts. Yet, once the background of this case is known, or once one reads the opinions of the Court of Appeals or of the Probate Court, or the briefs submitted by the parties and the amici curiae, the inadequacies of the opinion become apparent. In our view, the Spring decision works a disservice on all those both within and without Massachusetts who seek guidance from the courts as they attempt to resolve similar cases.

The Illinois Association of Hospital Attorneys [IAHA], among others, filed a brief amicus curiae in the Spring case for three reasons: First, to ask that the SJC reconsider the position it had taken in Saikewicz, and thereby to alleviate some of the misunderstanding caused by that decision. Second, to ask the court to reconsider whether the tests it enunciated in Saikewicz were truly workable in the contemporary health care delivery system.