Abstract
The patients with end-stage renal disease on maintenance hemodialysis occasionally develop serious concomitant diseases which require hospitalization. The incidence of psychosis seems to be slightly increased in patients on maintenance hemodialysis. One hemodialysis patient with recurrence of atypical psychosis was admitted to a psychiatric ward. We encountered great difficulty in making arrangements for admission to a general hospital with both an isolation ward for psychotic patients and a hemodialysis center. The patient was finally admitted to a professional psychiatric hospital located one hour by car from our hospital, and hemodialysis treatment was carried out at the out-patient clinic in our hospital. Two nursing staff accompanied him on the way to and from our hospital.
A questionnaire surveying the circumstances of hospitalization for patients with concomitant end-stage renal disease and psychosis was sent to all hemodialysis units in Aichi prefecture. The questionnaire inquired regarding the prevalence and type of psychoses encountered during the last one year, the inevitability of hospitalization, problems in the process of admission and the consequences, problems during hemodialysis treatment and nursing plans. Responses were collected from 72 (65%) of 111 hospitals. Among 4, 418 uremic patients, 62 patients (1.4%) with psychosis were enrolled in the analysis. The most common psychosis was manic-depressive illness (n=24), and the second most common was sizophrenia (n=14) and the third was senile dementia. Regarding age distribution in uremic patients with psychosis, the highest prevalence was found among those in their fifties. Hospitalization was indicated in 20 (32%) of 62 psychotic patients. Only five patients were admitted to a general hospital where professional treatment in a psychiatric ward and hemodialysis were both available in the same hospital. Fifteen (75%) of 20 patients had several problems in the process of admission. Six patients were admitted to professional psychiatric hospital, and had to be transported to other hospitals as outpatients for hemodialysis. Six other patients were admitted to ordinary wards in hospitals without professional psychiatric ward. The remaining three patients were not admitted to any hospital. Several nursing plans; isolation, sedation during hemodialysis, restriction, attendance by family and/or an exclusive nursing staff and so on, were necessary for safe hemodialysis treatment.
A regional network is urgently needed to provide optimal therapy for hemodialysis patients with serious complications including psychosis.
