Psychological impact found in adolescents with kidney transplants

[okarol]

Psychological impact found in adolescents with kidney transplants

A new study describes the psychological profile of adolescents who have received kidney transplants and compares them to those of healthy peers. The findings reveal a significantly higher prevalence of psychiatric conditions (depression, phobia, ADHD), educational impairment and social isolation among adolescents who had undergone a transplant.

The study appears in Pediatric Transplantation.

In the transplant group studied, 65 percent were diagnosed with a lifetime psychiatric disorder, compared to 37.5 percent in the control group. Transplant recipients also showed significantly more mood disorders than the control group, nearly twice the frequency of anxiety disorders and more behavioral disorders.

Young adults with childhood kidney conditions also show difficulties in tasks requiring concentration and memory. 22.5 percent of the overall transplant group and 31 percent of boys suffered from ADHD. The prevalence of school problems and learning difficulties also was high; as 30 percent had learning difficulties and 60 percent had repeated at least one school grade.

Compared to other young adults who grew up with a chronic or life-threatening disease (including childhood cancer), kidney disease patients have been shown to have a delay in independent behavior. 37.8 percent of transplant recipients studied had borderline/clinical social competence diagnoses and were found to be more withdrawn and isolated than their peers.

Post-operative treatment after transplantation includes a lifetime of immunosuppressive drugs, clinic visits and intrusive tests such as biopsies. Immunosuppression carries its own risks by causing susceptibility to infection and malignancies, or other side effects.

Non-adherence to this treatment may be as high as 25 percent in adolescent transplant recipients, and carries an additional set of problems. It was found to be associated with higher levels of psychological distress (low self-esteem, depressive symptoms, and behavioral problems).

While many physical, psychological, social and cognitive changes take place in adolescence, regardless of physical condition, adolescents with chronic conditions have lower emotional well-being scores, worry more and have poorer body image. They are more socially isolated and have limited opportunities for psychosexual development and peer relationships. Adolescents with this condition are also more likely to exhibit symptoms of depression.

These symptoms in adolescence strongly predict an episode of major depression in adulthood. Adolescent anxiety and depressive disorders have also been associated with increased frequency of personality disorders and dysfunction in community samples followed-up in young adult life. Adolescents transplant patients may therefore remain at risk of developing psychiatric disorders after they are transferred to the adult care system.

“These dimensions should be routinely screened for in patients, both before and after transplant and appropriate steps should be taken when needed, such as psychiatric/educational support and the promotion of social activities,” says Dr. Eric Fombonne, co-author of the study. “Because transplant patients face a lifelong disease and may remain at risk for developing psychiatric disorders, special attention should be paid when transferring their care from pediatric to adult services.”

By Wiley-Blackwell

http://www.huliq.com/11/77138/psychological-impact-found-adolescents-kidney-transplants

[kitkatz]

Give the teens a transplant and make them crazy! Is that it?   I think maybe better psychiatric treatment for these kids is needed. Plus more support for them.

[Kitsune]

I can guess pretty fairly that teens on dialysis probably have a higher rate of these occurrences than teenage transplantees due to the fact that dialysis is more intrusive and time-consuming than having a transplant, and here are some of the reasons why.

1. But for the appointments, biopsies, and anti-rejection medicine, teenage transplantees have the freedom to pretty much go where they want, do what they want and eat what they want whereas teens on dialysis are tied to a machine three times a week therefore many of them fall behind in school and/or social skills activities, many of these teens also have problems making fiends due to that they may not have time for "hanging out" in between school, dialysis sessions and chores. Also of note is that the renal diet is a very hard diet to follow, even for adults and excludes many food items that appeal to teenagers.

2.Dialysis requires an access (fistula, A/V graft, catheter) that teens on dialysis may find embarrassing or freakish, and this may reduce their self-esteem and ability to attract teens of the opposite gender for dating due to lack of confidence, whereas teens with transplants appear normal and can "hide" their illness whereas teens on dialysis cannot due to either a large graft/fistula or the catheter lines hanging out of their body.

3. Dialysis is a very time-consuming process where the person receiving treatment is not permitted to move unless the tech (who sometimes will ignore you anyway) unhooks them, checks their blood pressure, re-transfuses them and tapes their lines or needles and must sit almost completely still for approximately 3-4 hours per session in an uncomfortable vinyl "recliner".

4. Teens on dialysis tend to have a shorter lifespan than teenage transplantees, therefore making them wonder about their future or even if they will have a future (the average lifespan of those who spend their entire lifetime on dialysis is said to be around 10-15 years, excepting exceptional cases, please correct me if I am wrong).

5. Many teens on dialysis also tend to be more dependent and fearful than their transplantee peers, due to the condescending attitudes of staff and some parents who talk to them like they are young children or warn them of possible (but highly unlikely) consequences that can happen to people on dialysis.

6. Many pediatric dialysis centers do not have strictly adolescent shifts, therefore limiting the teenager's (who must spend large amounts of time in said center) ability to make age and/or intellectually-appropriate friends in the same situation as they are, leaving them to feel as if they are an outsider in an otherwise healthy teenage society.

7. The mental aspect of not knowing if today will be your last and if you will die on the machine in front of anyone who cares to see it is a major source of ESRD-related depression, in all people on dialysis, including teens who do not have adult coping skills, therefore making the process yet harder for the young person.

These are the reasons that I feel that adolescents on dialysis may fare worse than their transplantee peers when it comes to social isolation, depression, poor self-esteem and confidence issues, but then again this is my (not-so-humble) opinion, so if anyone cares to comment, please do so and let me know what you think.