Renal transplantation: psychiatric aspects and interventions

This is a report on the clinical experience in consultation-liasion psychiatric service for patients with end-stage renal disease undergoing renal transplantation. Among a total of 30 patients (23 men and 7 women) 13 (43%) developed psychiatric disturbances: depressive state, 8; anxious-irritable state, 5; and delirious state, 1 (One patient had both depressive and delirious states). Five patients got depressed following the episodes of a rejection reaction. Three of them had a graftectomy which exacerbated their depressions. The occurrence of rejection reaction was thought to be a major precipitating factor. Four patients became anxious-irritable within a week following transplantation. Patient's intolerance to stressors seemed more responsible for the anxious-irritable state than stressors per se. Steroid medications were thought to be a predisposing, not a causal, factor to psychiatric disturbances in transplant patients. In the 21 patients who were assessed preoperatively and who had no rejection reactions, the Basic Rorschach Score of less than -20 was a predictor of posttransplant psychiatric disturbances. Psychiatric interventions were done for the 13 mentally ill patients in collaboration with the surgeons in charge and ward nurses. For the patients with the anxious-irritable state, listening, reassurance, and anxiolytics (sometimes with additional antipsychotics) were effective. For those who had a depressive state and who became uncooperative, "conjoint" sessions with the patients and their family members (e.g. spouses) were of therapeutic use.