Psychosis and pseudo dementia associated with hemodialysis

A patient treated with hemodialysis developed psychotic episodes, including visual hallucinations and delusions, as well as symptoms similar to the fatal dialysis dementia. His hospital course seems to demonstrate an original organic dysfunction with behavioral sequelae that were perpetuated by psychological difficulties. His tendency to overdramatize his disability and to adopt an excessively helpless and passive role made treatment difficult. A one-year followup is provided along with a discussion of the relationship of his case to dialysis dementia.

The effect of a token economy on dietary compliance for children on hemodialysis

Adherence to dietary restrictions is a recurring problem for children on hemodialysis. The effect of behavior modification in maintaining dietary control is reported for four patients aged 11 to 18 years. Weight gain, potassium level, and blood urea nitrogen were utilized as criteria measures. A token reinforcement program implemented by the hemodialysis team resulted in significant changes in the dietary pattern of the children. The average weight gain between dialysis sessions for the four subjects during treatment was reduced by 45% and the degree of weight fluctuation was lessened. Potassium levels and BUN were controlled to their appropriate level for subjects who initially exceeded the criterion level. With the withdrawal of weight gain from the contingency system, increase of weight gain between dialysis sessions was noted for all subjects.