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Yıl:2012; Cilt: 2; Sayı: 1>> Özet
Psikiyatride Güncel; 2012;2(1):32-43
Kronik böbrek hastalığında psikiyatrik tanı ve tedavi ilkeleri
AY Özpolat, C Göker
Ankara Üniversitesi,Ankara
Kronik böbrek yetmezliği (KBY), kronik seyirli böbrek hastalıklarında ilerleyici nefron kaybı sonucunda böbrek fonksiyonlarının giderek
bozulması ile ortaya çıkan, glomerül filtrasyon hızının (GFH) azalması ile kendini gösteren ve yaşamı tehdit eden bir tablodur. KBY sıklığı
günümüzde giderek artmaktadır. Tedavide kullanılan renal replasman yöntemleri olan hemodiyaliz (HD), periton diyalizi ve böbrek nakli
içinde en çok başvurulan yöntem hemodiyalizdir. Ülkemizde 25000’in üzerinde hasta diyaliz tedavisi ile yaşamını sürdürmektedir. Hayat
kurtarıcı bir yöntem olmakla birlikte HD tedavisinin birçok komplikasyonu vardır. SDBY nedeniyle HD programında olan hastalarda,
başta depresyon ve anksiyete olmak üzere, ruhsal bozukluk oranlarının yükseldiği ve eşlik eden ruhsal bozuklukların 1.5-3 kata varan oranlarda
daha fazla hastane yatışlarına neden olduğu bildirilmektedir. Hem hastalığın kendisi, hem de sürekli makine ve tedavi ekibine bağımlı
olma hastanın yaşam kalitesini de olumsuz etkilemektedir. Bu süreçte psikiyatristler, nefrologlar ve hastayı tedavi eden ekip sinerji geliştirerek,
hastanın risk davranışlarını belirlemek, diyalize uyumuna yardımcı olmak, yaşam kalitesini artırmak, gelişebilecek psikopatolojilerin
erken tanı ve tedavisini sağlamak, nakil için bekleme dönemi sırasında eğitim ve destek sağlamak görevlerine sahiptir.
Psychiatric diagnosis and treatment principles in chronic renal failure
Chronic renal failure (CRF) is a life-threatening condition which is manifested by reduction in glomerular filtration rate (GFR), with
gradually impaired renal function as a result of progressive loss of nephrons in chronic renal diseases. Currently the prevalence of CRF
is increasing. Among the renal re-placement methods used for treatment such as hemodialysis (HD), peritoneal dialysis and renal
transplantation, hemodialysis is the most widely used one. In our country, more than 25000 patients maintain their lives with dialysis
treatment. Although life saving, HD treatment have several complications. In patients on HD program with end stage renal failure,
increased rates of psychiatric disorders and comorbid mental disorders especially depression and anxiety, have been reported to cause
increased hospitalization rates up to 1.5 to 3 times. The patient’s quality of life is negatively affected by both the disease itself, as well
as being continuously dependent on the machine and the treatment team. Throughout this process, psychiatrists, nephrologists and the
treatment team have duties to determine the patient’s behavioral risks, to help compliance to dialysis, to improve the quality of life, to
ensure early diagnosis and treatment of probable psychopathology and to provide education and support, by developing a synergy during
the waiting period for transplantation.

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