Psychiatric illness is common among patients with chronic disorders, particularly in those with end-stage renal disease (ESRD). A review found the following mental disorders were frequently observed :
- Affective disorders, particularly depression
- Organic brain diseases (eg, dementia and delirium)
- Drug-related disorders (such as alcoholism)
- Schizophrenia and other psychoses
- Personality disorders
These disorders account for a 1.5 to 3.0 times higher rate of hospitalization among dialysis patients compared to those with other chronic illnesses, thereby resulting in significant morbidity. In the previous study of approximately 175,000 dialysis patients, 9 percent were hospitalized with a mental disorder during a one-year period . A subsequent study from Japan reported a one-year 10.6 percent incidence of psychiatric disorders in dialysis patients . Dementia, delirium, and major depression were the most common disorders in this four-year follow-up study.
Patients maintained on hemodialysis are more likely to be hospitalized for a psychiatric disorder than are those treated with peritoneal dialysis. This difference may be due to patient selection for a particular dialysis modality or the increased incidence among hemodialysis patients of disruptive behaviors that may lead to hospitalization . Overall, the type of dialysis modality does not appear to have a significant impact upon symptoms related to depression, sexual function, and life satisfaction .
There is a paucity of data relating to the effectiveness of therapeutic interventions in the treatment of psychiatric disorders occurring in patients with ESRD. It is unclear if the management is less successful, and thus hospitalization is more common. Resistance to therapy may also contribute to higher hospitalization rates.