[Testament's ability in Balkan endemic nephropathy].

INTRODUCTION: Testament is a solemn, authentic instrument in writing, by which a person declares his or her will as to disposal of his or her estate, and it has a psychopathological, lawful and ethical importance to a person, family and society. The aim of the study was to assess if the ability to make a testament was more damaged in patients with Balkan Endemic Nephropathy (BEN) than in patients with other diseases that resulted in Chronic Renal Failure in Bosnia and Herzegovina in the period from the 1st January 2001 to 31st December 2006. MATERIAL AND METHODS: The 753 respondents were divided into two groups in the study: BEN group (n=150) and control group made of patients with other diseases resulting in CRF (n=150). In a multicentric longitudinal study we used: adapted questionnaire from the Renal Register of Bosnia and Herzegovina, Hamilton Depression Rating Scale, and Mini-Mental State Examination. Descriptive analysis, discriminative function and regression model have been done statistically. RESULTS: In BEN group, heirs are mostly mentioned - 84.0% (t=14.391; P=0.001), and in control group: heirs - 66.6%, relatives - 43.3% (t=7.751; P=0.003), carers - 44.0% (t= 6.678 P=0.032), and institutions 10.0% (t=5.147, P=0.061). The discriminative function shows differences between BEN and control group: canonical correlation (rc) =0.827, Wilkinson lambda (lambda nj) =0.871, Chi-square test =141.575 and significance (P=0.001). The regression course of the analysis can be used for prediction of the ability to make testament for the patients on dialysis. [y=-0.95x + 15.715, and OR = 0.785, (95%) for CI = -0.997 - -0.375); Can Fanc r2=0.861: Significance is P=0.002]. CONCLUSION: The ability to make a testament is more damaged in patients from the nephropathy group than in the patients from the control group who are on dialysis in Bosnia and Herzegovina. This has been confirmed by socio-demographic and psychological parameters, and it is very important for preservation of the ethic norms of the patients on dialysis, responsibility of the expert teams and persons who are benefitiaries of the testament.

Euthanasia of patients with the chronic renal failure.

This study deals with frequency and form of euthanasia in dialysis patients with chronic renal failure (CRF) in Bosnia and Herzegovina (B&H) within the period from 2000 to 2006. Of total number of 2700 patients on dialysis we examined n = 753 of them. Examinees with the Balkan Endemic Nephropathy (BEN) (n = 348) were in the first group, and the Control group was formed of patients with other diseases (n = 405). In this study the following methods were used: adapted Questionnaire from the Renal Registry of B&H, Beck's Anxiety Inventory (BAI), Hamilton's Depression Rating Scale (HDRS) and Mini-Mental Scale of Estimation (MMSE). Age of the BEN group of patients ranged: 64.77 +/- 8.86 and the control one 53.85 +/- 3.60. Multivariate analysis for the BEN group with passive euthanasia was: 0.760 (95%, CI = 0.590-0.710) (p = 0.001) and for the active one was 0.450 (95%, CI = 0.125-0.510 (p = 0.001). Euthanasia is associated with the rural life and renal heredity, and psychological BAI scale-total, HDRS-total and MMSE-total. For the BEN group passive euthanasia is 3.75% as well as active 0.86%. The findings stressed that euthanasia of dialysis patients requires better nephrological-psychiatric control and social care in B&H as well as complete program for the CRF samples protection too.

Anthropological aspect of death in dialyzed patients.

The aim of this article is to compare the incidence of thanatophobia in dialysed patients having Balkan endemic nephropathy (BEN) with a control group (N18) members where some of them have chronic renal failure (CRF), but not (BEN). We examined thanatophobia on a sample of 753 dialysed patients with chronic renal failure (CRF) in Bosnia and Herzegovina (B&H) during the period from 1st January 2000 to 31st December 2006. The first group is a cohort consisted of 348 patients with Balkan endemic nephropathy (BEN), and the control group consisted of 405 randomly selected patients with different diagnoses of CRF (N18). The measurement instruments used were: General data list, Eysenck's Personality Questionnaire (EPQ), Beck's Anxiety Inventory (BAI), Hamilton's Depression Rating Scale (HDRS), and Mini-Mental State Examination (MMSE). Univariante and multivariante statistical analyses were carried out. From the multivariante analysis, the highest correlations with thanatophobia were found in these variables: avoidance of dialysis in BEN group: R=0.985, OR=0.358, CI=0.483-0.728 (95%), and in control group: R=0.550, OR=0.935, CI=0.615-0.830 (95%), age, years on dialysis, education, pervasive fear with statistical significance P=0.001. BEN group differentiates from control group: BAI-total (R=1.110, OR=0.578 (95%), CI=0.770-0.890, P=0.001), HDRS-total (R=0.995, OR=1.290 (95%), CI=1.180-1.920 P=0.001. BEN group have lower scores than the control group in MMSE-total: (R=0.430, OR=0.023 (95%), CI=0.034-2.850, P=0.001) which represents the organic part of anxiety. Thanatophobia is present in both groups, but it is more frequent in the BEN (11.70%) than in control group (7.50%). We found that thanatophobia occurs before dialysis, and that it is structured as a pervasive fear of death and is associated with endemia, years spent on dialysis, and avoidance of dialysis.

Depersonalization in Balkan endemic nephropathy.

UNLABELLED: Aim of the study was to confirm depersonalization/derealization in patients with Balkan endemic nephropathy in comparison with other patients on dialysis in Bosnia and Herzegovina within the period 01.01.2000 -31-12-2006. years. METHOD: Examined were 753 out of 2770 dialyzed patients and they were divided into two groups: those with Balkan endemic nephropathy--BEN group (N+348) and the control group of other diseases N18. Patients were followed-up form 01.01.2000 to 31.12. 2006. when the study was made. It is comparative, cross-sectional study and Questionnaire from the renal Registry of B&H adapted to the mental health and psychological tests--Eizenck's personality characteristics test, Hamilton Depression Rating scale (HDRS) and Mini Mental State evaluation were used. RESULTS: Depersonalization was in BEN group present in 3.50% of cases (chi2 = 70.880, df = 2 p < 0.001), a derealization in 3.75% (chi2 = 117.678, df = 2, p < 0.002) and depersonalization/ derealization in 1.19% of them (chi2 = 218.457, df = 2, p < 0.002). Regression analysis was: y = -0.93x + 14.818, a CI = 95% for Fisher's (Z = -0.995462 to -0.26481). CanFanc r2 = 0.86, P = 0.002 za 87.5% for depersonalization prediction in HRF. CONCLUSION: In patients on dialyzed treatment in BaH depersonalization sui generis was found in group BEN 3.50% of cases, derealization in 3.57% of them and in group N18 depersonalization in 3.32% of them and possibility to predict depersonalization is 87.50%.

[Anxiety disorders in dialysis patients].

INTRODUCTION: Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease. MATERIAL AND METHODS: This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H) in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN), and the control group included 405 patients with other diagnoses causing renal insufficiency (N18). The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods. RESULTS: Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural) (chi2 = 23.970) p < 0.01: in the incidence of renal comorbidity (chi2 = 23.970) p < 0.01, familial renal comorbidity (chi2 = 23.970) p < 0.01 and mnigrations (chi2 = 4.874) p < 0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p < 0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p < 0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examnination pointing to general mental weakness. CONCLUSION: Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk.

[Thanatophobia in the patients on dialysis].

BACKGROUND/AIM: Thanatophobia is an exaggerated, specific, structured fear of death. It appears in childhood and continues to grow over the years, and in the old age it is accompanied with nosophobia and other mental disorders. The aim of this study was to analyze thanatophobia in dialysed patients which was in the direct connection with a basic disorder, and the influence of this disorder on functioning and the quality of life of the patients on dialysis. METHODS: In the study we examined 753 patients from the chronic program of haemodialysis in a period from 1999 to 2004. The patiens were classified in two groups: 348 randomized patients with Balkan Endemic Nephropathy (BEN), and the control group (N18) of patients with terminal renal insufficiency, and other diagnoses (n = 405). Since the study was a comparative, cross-sectional one, the patients were tested by the appropriate questionnaires for anxiety, depression and general mental functioning. Statistical analysis was done by the standard descriptive and analytic statistic methods. RESULTS: Based on socio-demographics data we revealed a highly significant difference regarding the place of living between the groups BEN and N18 (chi2 = 23.970; p < 0.01), the frequency of occurrence of renal comorbidity (chi2 = 23.970; p < 0.01), the frequency of familly renal comorbidity in siblings (chi2 = 23.970; p < 0.01), and the frequency of migrationes (chi2 = 4.874; p < 0.01). According to psychiatry scales, the patiens from the BEN group were significantly more anxious and depressive than those from the control group. CONCLUSION: The signs of thanatophobia were revealed in both examined groups, but significantly more in the patients with BEN than in those with other nephrologic diseases. Thanatophobia starts before dialysis, and dialysis structures it into fear of death which is in a direct connection with the basic disorder. This intensive fear may be connected with dementia and depression, but also with other mental disorders.