腎移植後の精神医学的問題とその予防(<特集>術後の心身医学的諸問題)

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We studied the psychiatric problems after kidney transplantation of the recipients at Kitasata University Hospital from 1972 to 1988. We were considering that psychiatric disturbances were induced by distortion or lack of feedback function in cerebral and/or interpersonal communication. This thought was affective to understand these disturbances for recipients, family and the medical staff, and to take care and prevent these problems. Depressive state was the most important problem and observed in 61 recipients (24.1%). Most of them were related to a guilt-shame feeling toward the donor, loss of future, discouragement, and high dosage of steroid. Some of them were related to the donor's demand of independence and better social adjustment. A markedly dependent and withdrawn state was observed in 5 adolescents after severe rejection, but they fell into depression after decision of removal of the gifts, several years later. A markedly dependent and regressive or symbiotic state was observed in 31 child, adolescent and young single adult recipients who were gifted from their mothers. A delirious state was observed in 21 adult recipients, but in no child and adolescent recipients in spite of more dosage of steroid per kg. This state was related to cerebral arteriosclerosis, hypertension and discouragement. A markedly anxious, irritable and hypochondriacal state was observed in 46 recipients. Many of them who had been experienced acute rejections suffered from Damocles syndrome. Conversion hysteria was shown in 8 young recipients who were suffering from fear of abandonment from their donor and family. Body-image disturbance was observed in 16 adolescent and young adult recipients. Many of them were suffering from Cushingmoid appearances and strange sensation of abdomen or wound of operation. A delirious and illusional state was observed in two young recipients. One was only in the hospital for delivery, the other had been paranoic and injured the doctor with persecutive illusion. With regard to the causes of the postoperative psychiatric problems, there were many possible factors; physically, renal rejection, complications, high dosage of steroids; psychologically, fear of rejection, guilt-shame feeling toward the donor intrafamiliar conflict, stress of school and social lives, demands for independence and changes in appearance due to steroid. Psychiatric problems were induced in complicated combination with multiple factors, and developed by distortion of communication with the donors and medical staffs. From this point of view, multidimensional and comprehensive approaches should be taken in management of post-operative psychiatric problems. Moreover, we are expected to consider quality of lives of patients and mental development of the child and adolescent patients, having better and reciprocal communication with patients and their families.
日本心身医学会の論文
1992-12-01

腎移植後の精神医学的問題とその予防(<特集>術後の心身医学的諸問題)

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