The role of the psychiatrist in obtaining informed consent from patients with somatic and mental comorbidity: Report of one case / Obtención de consentimiento informado por un psiquiatra en un paciente con una enfermedad somática: Informe de un caso

The nature of mental disorders, the attitudes and prejudices of the social community towards psychiatric patients, the behavior and treatment of mental patients, all bring about numerous dilemmas and prejudices. When a patient is diagnosed with a mental disorder, he may suffer restrictions in the field of general human rights. However, the biggest problems in clinical practice occur in the treatment of patients who, besides their mental disorder also have a somatic disease. We report a 56-years-old female with a severe renal failure who refused to undergo dialysis. Following the patient's refusal to sign an informed consent, a psychiatrist was called in for consultation and diagnosed an acute psychotic reaction. To manage the delusions and acute psychotic reactions, risperidone in the dose of 2 mg was started. After 22 days, the patient still had marked psychotic symptoms. A psychiatrist, a nephrologist and an anesthesiologist, in the presence of the spouse on the grounds of her life-threatening condition, decided to apply the necessary medical procedures even without the patient's consent. A day after the start of dialysis the patient still had delusional ideas, but without the presence of anxiety, and the patient no longer offered resistance to dialysis. Four days after the first dialysis, the patient was calm, had vague memories about the entire previous period, and signed the informed consent concerning her further treatment.

Se generan muchos dilemas y prejuicios debido a la naturaleza de las enfermedades mentales. Cuando a un paciente se le diagnostica un cuadro mental, sus derechos humanos pueden verse perjudicados. Sin embargo, los mayores problemas se suscitan en pacientes que además de tener un trastorno mental, tienen una enfermedad somática. Presentamos una mujer de 56 años con una falla renal que rechazó ser dializada. Después que la paciente no firmó el consentimiento informado, se pidió una interconsulta a psiquiatría y se diagnosticó una reacción psicótica aguda. Se indicó risperidona para tratar las alucinaciones. Después de 22 días de tratamiento la paciente aún tenía síntomas psicóticos. Una junta médica efectuada en la presencia del cónyuge de la paciente, decidió efectuar la diálisis a pesar del rechazo de la paciente. Un día después de dializarse, la paciente aún tenía alucinaciones pero menos ansiedad y dejó de rechazar la diálisis. Cuatro días más tarde la paciente no recordaba lo ocurrido y firmó el consentimiento para dializarse.

Depression in hemodialysis patients

To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1[st] January 2006 to 30[th] April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II [BDI-II; adapted in Urdu] was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers [Anti HCV and HbsAg]. Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM IV] for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two [58.4%] were male and seventy seven [86.5%] were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +/- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty [56.1%] were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters

Atendimento psicológico a pacientes com insuficiência renal crônica: em busca de ajustamento psicológico / Psychological treatment for patients with chronic kidney disease: searching for psychological adjustment

As doenças crônicas, entre elas a insuficiência renal crônica, têm recebido grande atenção dos profissionais de saúde nas últimas décadas devido ao importante papel desempenhado na morbimortalidade da população mundial. Este trabalho pretende apresentar um relato de experiência sobre o atendimento psicológico, realizado numa clínica de hemodiálise, de 26 pacientes com idades entre 15 e 80 anos, a maioria mulheres (69,2 por cento), casados (53,8 por cento), que não trabalham (92,3 por cento) e aposentados (57,7 por cento), fazendo hemodiálise três vezes por semana. No lugar de reagir passivamente a eventos negativos, indivíduos podem se comportar de modos que aumentem seu bem-estar em tempos de desafios e mudanças, como no caso de se ter uma insuficiência renal crônica. A forma como as pessoas lidam com o sofrimento e seus benefícios pode trazer possibilidades de ajustamento e crescimento pessoal frente à adversidade.

Chronic illnesses, such as kidney disease, have received great attention from health professionals in the last decades. This work intends to present an experience with psychological care, in a hemodialysis clinic, with 26 patients aged between 15 and 80 years, the majority of which were women (69,2 percent), married (53,8 percent), did not work (92,3 percent), or were retired (57,7 percent), taking hemodialysis three times a week. Instead of reacting negatively to life events, individuals can behave in ways that improve their well-being in times of transformation and change, as is the case when one has a chronic kidney disease. The manner in which the individual deals with suffering and its benefits can bring possibilities of psychological adjustment and personal growth in face of adversity.