Anxiety disorders in adults treated by hemodialysis: a single-center study.

Cukor D, Coplan J, Brown C, Friedman S, Newville H, Safier M, Spielman LA, Peterson RA, Kimmel PL.

Source

Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY 11203-2098, USA. daniel.cukor@downstate.edu

Abstract

BACKGROUND:

Anxiety is a complicating comorbid diagnosis in many patients with medical illnesses. In patients with end-stage renal disease (ESRD), anxiety disorders often are perceived to represent symptoms of depression rather than independent conditions and therefore have been relatively understudied in this medical population.

STUDY DESIGN:

To evaluate the psychosocial impact of anxiety disorders on patients with ESRD, we sought to identify the rates of these disorders in a sample of patients receiving hemodialysis at a single center by using a structured clinical interview. We also compared a commonly used screening measure, the Hospital Anxiety and Depression Scale (HADS), with these clinical diagnoses to determine the measure's criterion validity or ability to predict a psychiatric diagnosis in ESRD populations. Finally, we examined the relationship between anxiety diagnosis and perceptions of quality of life (QOL) and health status.

SETTING & PARTICIPANTS:

A sample of 70 randomly selected hemodialysis patients from an urban metropolitan center.

PREDICTOR:

Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Diagnosis (SCID-I).

OUTCOMES:

HADS and Kidney Disease Quality of Life Short Form.

RESULTS:

Using the SCID, 71% of the sample received a DSM-IV Axis I diagnosis, with 45.7% of subjects meeting criteria for an anxiety disorder and 40% meeting criteria for a mood disorder. The concordance between DSM-IV anxiety disorders and anxiety scores acquired by using the HADS was not significant. Thus, although the HADS may provide an acceptable measure of overall "psychic distress" compared against the SCID-I, it has poor predictive power for anxiety diagnoses in patients with ESRD. Additionally, the presence of an anxiety disorder was associated with an overall perceived lower QOL (t = 2.4; P < 0.05).

LIMITATIONS:

Single-center study and a population not representative of US demographics.

CONCLUSIONS:

A substantial proportion of participating patients met criteria for an anxiety disorder. The utility of the HADS as a screening tool for anxiety in patients with ESRD should be questioned. The finding that anxiety disorders negatively impact on QOL and are not merely manifestations of depression in patients with ESRD emphasizes the importance of accurate diagnosis and effective treatment. Strategic options are necessary to improve the diagnosis of anxiety disorders, potentially enhancing QOL and medical outcome in patients with ESRD.

PMID:

18440682

[PubMed - indexed for MEDLINE] 

http://www.ncbi.nlm.nih.gov/pubmed/18440682

Mental health, depression, and anxiety in patients on maintenance dialysis.

Feroze U, Martin D, Reina-Patton A, Kalantar-Zadeh K, Kopple JD.

Source

Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, and Department of Psychiatry, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA.

Abstract

Depression and anxiety are among the most common comorbid illnesses in people with end-stage renal disease (ESRD). Patients with ESRD face many challenges which increase the likelihood that they will develop depression or anxiety or worsen these conditions. These include a general feeling of unwellness; specific symptoms caused by ESRD or the patient's treatment; major disruptions in lifestyle; the need to comply with treatment regimens, including dialysis schedules, diet prescription, and water restriction; ancillary treatments and hospitalizations; and the fear of disability, morbidity, and shortened lifespan. Depression has been studied extensively in patients on maintenance dialysis, and much effort has been done to validate the proper screening tools to diagnose depression and to define the treatment options for patients on maintenance dialysis with depression. Anxiety is less well studied in this population of patients. Evidence indicates that anxiety is also common in maintenance dialysis. More attention should be paid to measuring the incidence and prevalence and developing methods of diagnosis and treatment approaches for anxiety in patients with ESRD. In this review, we attempted to underscore those aspects of depression and anxiety that have not been investigated extensively, especially with regard to anxiety. The interaction between racial/ethnic characteristics of patients on maintenance dialysis with depression and anxiety needs to be studied more extensively, in order to assess better approaches to healthcare for these individuals.

PMID:

20622304

[PubMed - indexed for MEDLINE] 

http://www.ncbi.nlm.nih.gov/pubmed/20622304

Anxiety and depression in maintenance dialysis patients: preliminary data of a cross-sectional study and brief literature review.

Feroze U, Martin D, Kalantar-Zadeh K, Kim JC, Reina-Patton A, Kopple JD.

Source

Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA.

Abstract

BACKGROUND:

Anxiety and depression affect the quality of life of maintenance dialysis (MD) patients. There is little information concerning the extent to which the experience of individual hemodialysis treatments engenders anxiety in this patient population. This preliminary study examined the prevalence and severity of anxiety and depression in MD patients and the incidence of anxiety related to dialysis treatment.

METHODS:

One hundred seventy patients, 155 undergoing maintenance hemodialysis and 15 undergoing chronic peritoneal dialysis, were examined. Inclusion criteria included dialysis vintage of at least 6 months. Patients completed the Beck Anxiety Inventory and Beck Depression Inventory and questionnaires that examined their feelings of anxiety related to individual hemodialysis sessions.

RESULTS:

Patients' mean age was 56 ± standard deviation of 16 years; dialysis vintage, 55 ± 48 months; 46% were female. The data confirmed a high prevalence of anxiety and depression in MD patients. Many MD patients become anxious, often severely, by merely going for routine hemodialysis treatment and also owing to such common events as being connected to the hemodialyzer by a new person or on hearing their hemodialyzer alarm sound.

CONCLUSION:

Anxiety and depression are common in MD patients. Many patients who are well established on MD experience anxiety during individual maintenance hemodialysis treatments.
Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

PMID:

22200444

[PubMed - indexed for MEDLINE] 

http://www.ncbi.nlm.nih.gov/pubmed/22200444

A psychological intervention to improve quality of life and reduce psychological distress in adults awaiting kidney transplantation.

Rodrigue JR, Mandelbrot DA, Pavlakis M.

Source

Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA. jrrodrig@bidmc.harvard.edu

Abstract

BACKGROUND:

Adults with end-stage renal disease who are awaiting kidney transplantation are at risk for low quality of life, high psychological disturbance and relationship distress. Effective psychological interventions to improve functioning in these areas are lacking.

METHODS:

Sixty-two adults approved for kidney transplantation at one centre in the USA were randomized to quality of life therapy (QOLT), supportive therapy (ST) or standard care (SC) with repeated assessments of quality of life, psychological distress, and social intimacy at pre-intervention (T1), 1 week post-intervention (T2) and 12-week follow-up (T3).

RESULTS:

QOLT patients had higher quality of life scores than ST and SC patients at T2 and T3, and higher social intimacy scores compared with SC patients at T3. Both QOLT and ST patients had lower psychological distress scores compared with SC patients at T2, although only QOLT continued to show reductions in psychological distress scores relative to SC patients at T3.

CONCLUSIONS:

The findings show that it is possible to improve quality of life, psychological functioning and social intimacy with QOLT while patients await kidney transplantation. Study limitations include small sample size, single-centre study and possible patient self-selection biases. Future research will examine whether QOLT effectiveness is affected by treatment modality (face-to-face vs. telephone) and timing (pre- vs. post-transplantation).

PMID:

20603243

[PubMed - indexed for MEDLINE]

PMCID:

PMC3108357

http://www.ncbi.nlm.nih.gov/pubmed/20603243

Anxiety disorders in adults treated by hemodialysis: a single-center study.

Cukor D, Coplan J, Brown C, Friedman S, Newville H, Safier M, Spielman LA, Peterson RA, Kimmel PL.

Source

Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY 11203-2098, USA. daniel.cukor@downstate.edu

Abstract

BACKGROUND:

Anxiety is a complicating comorbid diagnosis in many patients with medical illnesses. In patients with end-stage renal disease (ESRD), anxiety disorders often are perceived to represent symptoms of depression rather than independent conditions and therefore have been relatively understudied in this medical population.

STUDY DESIGN:

To evaluate the psychosocial impact of anxiety disorders on patients with ESRD, we sought to identify the rates of these disorders in a sample of patients receiving hemodialysis at a single center by using a structured clinical interview. We also compared a commonly used screening measure, the Hospital Anxiety and Depression Scale (HADS), with these clinical diagnoses to determine the measure's criterion validity or ability to predict a psychiatric diagnosis in ESRD populations. Finally, we examined the relationship between anxiety diagnosis and perceptions of quality of life (QOL) and health status.

SETTING &#38; PARTICIPANTS:

A sample of 70 randomly selected hemodialysis patients from an urban metropolitan center.

PREDICTOR:

Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Diagnosis (SCID-I).

OUTCOMES:

HADS and Kidney Disease Quality of Life Short Form.

RESULTS:

Using the SCID, 71% of the sample received a DSM-IV Axis I diagnosis, with 45.7% of subjects meeting criteria for an anxiety disorder and 40% meeting criteria for a mood disorder. The concordance between DSM-IV anxiety disorders and anxiety scores acquired by using the HADS was not significant. Thus, although the HADS may provide an acceptable measure of overall "psychic distress" compared against the SCID-I, it has poor predictive power for anxiety diagnoses in patients with ESRD. Additionally, the presence of an anxiety disorder was associated with an overall perceived lower QOL (t = 2.4; P < 0.05).

LIMITATIONS:

Single-center study and a population not representative of US demographics.

CONCLUSIONS:

A substantial proportion of participating patients met criteria for an anxiety disorder. The utility of the HADS as a screening tool for anxiety in patients with ESRD should be questioned. The finding that anxiety disorders negatively impact on QOL and are not merely manifestations of depression in patients with ESRD emphasizes the importance of accurate diagnosis and effective treatment. Strategic options are necessary to improve the diagnosis of anxiety disorders, potentially enhancing QOL and medical outcome in patients with ESRD.

PMID:

18440682

[PubMed - indexed for MEDLINE] 

http://www.ncbi.nlm.nih.gov/pubmed/18440682

The relationship between religious coping, psychological distress and quality of life in hemodialysis patients.

Ramirez SP, Macêdo DS, Sales PM, Figueiredo SM, Daher EF, Araújo SM, Pargament KI, Hyphantis TN, Carvalho AF.

Source

Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.

Abstract

OBJECTIVE:

No studies have evaluated the relationship among religious coping, psychological distress and health-related quality of life (HRQoL) in patients with End stage renal disease (ESRD). This study assessed whether positive religious coping or religious struggle was independently associated with psychological distress and health-related quality of life (HRQoL) in hemodialysis patients.

METHODS:

This cross-sectional study recruited a random sample of 170 patients who had ESRD from three outpatient hemodialysis units. Socio-demographic and clinical data were collected. Patients completed the Brief RCOPE, the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life instrument-Abbreviated version (WHOQOL-Bref).

RESULTS:

Positive or negative religious coping strategies were frequently adopted by hemodialysis patients to deal with ESRD. Religious struggle correlated with both depressive (r=0.43; P<.0001) and anxiety (r=0.32; P<.0001) symptoms. These associations remained significant following multivariate adjustment to clinical and socio-demographic data. Positive religious coping was associated with better overall, mental and social relations HRQoL and these associations were independent from psychological distress symptoms, socio-demographic and clinical variables. Religious struggle was an independent correlate of worse overall, physical, mental, social relations and environment HRQoL.

CONCLUSION:

In ESRD, religious struggle was independently associated with greater psychological distress and impaired HRQoL, while positive religious coping was associated with improved HRQoL. These data provide a rationale for the design of prospective and/or intervention studies targeting religious coping in hemodialysis populations.
Copyright © 2011 Elsevier Inc. All rights reserved.

PMID:

22281454

[PubMed - indexed for MEDLINE] 

http://www.ncbi.nlm.nih.gov/pubmed/22281454

Kemampuan koping terhadap tingkat kecemasan pada klien gagal ginjal kronik yang menjalani hemodialisa

Kecemasan merupakan suatu kondisi yang muncul bila ada ancaman ketidakberdayaan atau kurang pengendalian, perasaan kehilangan fungsi-fungsi dan harga diri, kegagalan pertahanan, perasaan terisolasi . Perilaku koping seperti mengingkari, marah, pasif atau agresif umum dijumpai pada pasien. Upaya koping mungkin efektif atau tidak dalam mengatasi stres yang mengakibatkan ansietas. Jika perilaku koping efektif, energi dibebaskan dan diarahkan langsung pada penyembuhan. Jika upaya koping gagal atau tak efektif maka keadaan tegang meningkat sehingga terjadi peningkatan kebutuhan energi lalu sumber penyakit nampak lebih besar.
Klien gagal ginjal kronik yang menjalani hemodialisa juga akan mengalami tingkat kecemasaan yang tinggi yang ditandai dengan perasaaan marah, sedih, badan gemetar, lemah, gugup, sering mengulangi pertanyaan, dan tanda-tanda vital meningkat. Sedangkan perilaku koping yang dijumpai yaitu klien sering mengingkari atau menyangkal, menangis, dan merasa takut akan kematian.
Individu dengan hemodialisa jangka panjang sering merasa khawatir akan kondisi sakitnya yang tidak dapat diramalkan dan gangguan dalam kehidupannya. Pengenalan kebutuhan rasa aman klien merupakan elemen penting dalam pendekatan holistik asuhan keperawatan yang meliputi aspek bio-psiko-sosio-spiritual, seperti kecemasan yang dialami klien gagal ginjal kronik yang menjalani hemodialisa memerlukan upaya penyesuaian dan penanganan agar individu adaptif. Jika individu mempunyai koping yang efektif maka kecemasan akan diturunkan dan energi digunakan langsung untuk istirahat dan penyembuhan. Jika koping tidak efektif atau gagal maka keadaan tegang akan meningkat, ketidakseimbangan terjadi, dan respon pikiran serta tubuh akan meningkat berupaya untuk mengembalikan keseimbangan. Untuk itulah perlu adanya pengembangan mekanisme koping sebagai pertahanan melawan kecemasan. Perawat berperan dalam membantu mengelola kecemasan dengan mengembangkan koping yang efektif, menciptakan lingkungan yang terapeutik, melibatkan keluarga atau orang terdekat klien, serta mencantumkan dalam intervensi keperawatan dengan harapan klien adaptif dan kualitas hidupnya meningkat.

http://grahacendikia.wordpress.com/2009/12/19/kemampuan-koping-terhadap-tingkat-kecemasan-pada-klien-gagal-ginjal-kronik-yang-menjalani-hemodialisa/