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Yıl:2009; Cilt: 10; Sayı: 2>> Özet
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Anadolu Psikiyatri Dergisi; 2009;10(2):142-150
Diyaliz Uygulanan Hastalarda Yaşam Kalitesi ve Psikiyatrik Belirti Dağılımı
A Özçetin, ZB Bahçebaşı, T Bahçebaşı, H Cinemre, A Ataoğlu
Düzce Üniversitesi Tıp Fakültesi Psikiyatri ABD, Düzce
Amaç: Son dönem böbrek yetmezliği (SDBY), hastalarda birçok psikososyal sorunlara neden olmakta ve yaşam kalitesini düşürmektedir. Biz çalışmamızda diyaliz hastalarının yaşam kalitesi ve psikiyatrik belirti dağılımını belir-lemeyi amaçladık. Yöntem: Çalışmamıza nefroloji ünitesi tarafından izlenen 54 hemodiyaliz (HD) ve 13 sürekli ayaktan periton diyalizi (SAPD) uygulanan toplam 67 hastayı aldık. Hastalara sosyodemografik bilgi formu, Short Form-36 (SF-36) Yaşam Kalitesi Ölçeği, Hastane Anksiyete ve Depresyon Ölçeği (HAD), Kısa Semptom Envante-ri (KSE) uygulandı. İstatistiksel analizde nonparametrik testlerden Mann Whitney-U uygulandı. Sonuçlar: Hasta-ların 31’i erkek, 36’sı kadındı. HD hastalarının yaş ortalaması 53.55±17.26 yıl, SAPD grubunun ise 47.83±13.76 idi. SF-36 alt ölçeklerinden hiçbirisinde HD ve SAPD grupları arasında fark yoktu. Psikiyatrik belirti dağılımını ölçen KSE alt ölçeklerinden ise, HD grubunda daha kötü olmak üzere somatizasyon (p=0.027) ve depresyonda (p=0.045) istatistiksel olarak anlamlı fark vardı. HAD anksiyete ve depresyon puanı eşik üstü olan hastaların yaşam kalitesi (SF-36) alt ölçeklerinin (anksiyete grubunda emosyonel rol alt ölçeği hariç p=0.186) tümü ve KSE alt ölçek puanları daha kötüydü ve istatistiksel olarak anlamlı fark vardı. Tartışma: Diyaliz uygulanan SDBY’li hastaların biyolojik değerlendirilmesine koşut olarak psikiyatrik yönden de değerlendirilmesi önemli görülmektedir. Hem yaşam kalitesi, hem de psikiyatrik belirti dağılımı yönünden kötüleşmeye neden olabilen depresyon ve/veya anksiyete kısa sürede ve kolayca uygulanabilen ölçeklerle tanınabilir. Bu sayede hastalara gerekli psikiyatrik destek sağlanarak yaşam kalitelerinin artırılabilmesinin yanı sıra, psikiyatrik belirtiler de daha kolay tanınıp gerekli önlemler alınabilir. Bu grup hastalarda psikiyatrik değerlendirme ve destek ihmal edilmeyecek kadar önemli görülmektedir. Bu sayede bakım verenlerin de tükenme sendromuna girmesi engellenebilir.
Quality of Life and Psychiatric Symptom Distribution in Chronic Dialysis Patients
Objective: End stage kidney failure cause many psychosocial problems and decrease quality of life (QoL). Our aim in this study was to determine QoL and psychiatric symptom distribution in chronic dialysis patients. Methods: Fifty-four chronic hemodialysis (HD) and 13 continuous ambulatory peritoneal dialysis (CAPD) patients (total 67 patients) who have been followed up by our nephrology unit have been included in this study. The tests applied in all patients were as following: Sociodemographic information form, Short Form-36 (SF-36) Quality of Life Scale, Hospital Anxiety and Depression Scale (HAD), Brief Symptom Inventory (BSI). Mann Whitney-U non-parametric test were used for statistical analysis. Results: There were 31 male, 36 female patients. Mean age in the hemodialysis group was 53.55±17.26 in the hemodialysis group and 47.83±13.76 in the CADP group. There no significant difference in the SF-36 sub-scales between two groups. According to the BSI sub-scales, there were significantly more somatization (p=0.027) and depression (p=0.045) in the HD group. All QoL subscales (except emotional role subscale in the anxiety group (p=0.186)) and BSI subscale points were statistically significantly worse among the patients who had over-threshold HAD anxiety and depression points. Conclusion: Psychiatric evaluation of chronic dialysis patients together with nephrologic evaluation seems quite important. Anxiety and/or depression, that cause deterioration in both QoL and psychiatric symptom distribution in these patients, can easily identified by quick and easily performed tests. By this way, psychiatric support can be provided to improve QoL, also psychiatric disorders can be early diagnosed, and thus necessary measures can be taken. Psychiatric evaluation and support seem to be very important and cannot be overlooked. By this means, caregiving “burn-out” syndrome can also be prevented.

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