Patients on forms of dialysis and those who receive kidney transplants face many stresses connected with their illness and forms of treatment. These stresses may result in a variety of psychiatric disorders and other problems. It is the duty of all nephrology personnel to be aware of these problems, and inquire about them so that the appropriate treatment may be instituted. The major stresses of dialysis involve conflicts of dependency and independency, unrealistic expectations, the medical regimen and the many losses these patients sustain. As a consequence of these stresses and other factors, patients experience depression, anxiety, sexual problems, psychosis, problems in rehabilitation and uncooperativeness. The therapies of these disorders include individual and group therapy and the use of psychologically active medications. The pharmacokinetics of medications used to treat these patients require special consideration of the route of elimination, whether or not the medication is dialyzable and theprotein binding of the medicine. Renal transplant patients may experience the same psychiatric problems, but usually of a lesser degree. Their special stress is termed "The Sword of Damocles'" that refers to anxiety associated with the wait and worry of organ rejection.
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