Psychonephrology: A Guide to Principles and Practice

Description

The book focuses on pharmacological and non-pharmacological approaches of psychiatric syndromes that commonly occur in patients with kidney disease. It specifically reviews principles of psychotherapy and psychopharmacology with an emphasis on organ impairment and drug-drug interactions specific to nephrology.   This book also covers issues with medication nonadherence in patients with chronic kidney disease and psychiatric comorbidity, as well as the associated issues in dialysis and renal transplantation. Additionally, chapters cover various other topics addressing an active stance towards health promotion in chronically ill patients, including the critical role of the diet and physical activity. Such advice is often complex and changing depending on the stage of chronic kidney disease and the individual needs of the patient.   Written by specialists in the field, Psychonephrology: A Guide to Principles and Practice serves as a valuable reference and teaching tool that provides an opportunity for learning across a rapidly evolving medical field. Foreword Preface Contents Contributors Part I: Fundamentals of Psychonephrology 1: Psychiatric Examination in Nephrology 1.1 Introduction 1.2 The Psychiatric Interview 1.2.1 Identifying Data 1.2.2 The Chief Complaint 1.2.3 History of Presenting Illness 1.2.4 Review of Systems and Substance History 1.2.5 The Past Psychiatric History 1.2.6 Past Medical History and Medications 1.2.7 Family History 1.2.8 Personal History 1.3 The Mental Status Examination 1.3.1 Starting with the ABCs: Appearance, Behavior, and Cooperation 1.3.2 Speech 1.3.3 Mood vs. Affect 1.3.4 Thought Process 1.3.5 Thought Content 1.3.6 Perceptual Disturbances 1.3.7 Cognition and Orientation 1.3.8 Insight and Judgment 1.4 The Risk Assessment 1.5 Concluding the Psychiatric Interview 1.6 Special Considerations in the Psychiatric Examination in Nephrology 1.6.1 Depression 1.6.1.1 Case Vignette 1 1.6.1.2 Case Vignette 1 Analysis 1.6.2 Anxiety 1.6.2.1 Case Vignette 2 1.6.2.2 Case Vignette 2 Analysis 1.6.3 Delirium 1.6.3.1 Case Vignette 3 1.6.3.2 Case Vignette 3 Analysis 1.7 Key Takeaways References 2: Psychometric Assessment of Neuropsychological Function in Kidney Disease 2.1 Introduction 2.2 Psychological Assessment 2.2.1 Common Psychiatric Presenting Concerns 2.2.1.1 Depressive Disorders 2.2.1.2 Case Vignette: “An Unfortunate New Beginning” 2.2.1.3 Suicidality 2.2.1.4 Anxiety Disorders 2.2.1.5 Sleep Disorders 2.2.2 Screening Tools 2.2.2.1 Depressive Disorders 2.2.2.2 Suicidality 2.2.2.3 Anxiety Disorders 2.2.2.4 Sleep Disorders 2.2.3 Case Vignette Analysis: “An Unfortunate New Beginning” 2.2.4 When to Refer for Psychological Assessment 2.3 Neuropsychological Assessment 2.3.1 Case Vignette: “Worsening Cognitive Changes in a Renal Transplant Patient” 2.3.2 Common Cognitive Difficulties 2.3.3 Cognitive Impairment across Disease Course 2.3.4 Case Vignette: “Worsening Cognitive Changes in a Renal Transplant Patient” (Continued) 2.3.5 Impact of Kidney Transplantation on Cognition 2.3.6 Cognitive Screening Tools 2.3.7 When to Refer for Neuropsychological Assessment 2.3.8 Case Vignette Analysis: “Worsening Cognitive Changes in a Renal Transplant Patient” 2.4 Key Takeaways References 3: Current State, Knowledge Gaps, and Management Strategies of Kidney Disease for the Psychiatrist 3.1 Case Vignette 3.2 Chronic Kidney Disease (CKD) 3.2.1 Defining CKD 3.2.2 Epidemiology of CKD 3.2.3 Evaluation of CKD 3.2.4 Complications and Management of CKD 3.2.5 Predicting Progression of CKD to ESKD 3.3 Renal Replacement Therapies 3.3.1 Hemodialysis 3.3.2 Peritoneal Dialysis 3.3.3 Transplantation 3.3.4 Conservative Kidney Care 3.4 Case Vignette Analysis 3.5 Key Takeaways References 4: Renal Transplant Essentials 4.1 Renal Transplant Statistics 4.2 Case Vignette 4.3 Pretransplant Considerations 4.3.1 Transplant Recipient Assessment 4.3.2 Transplant Donors 4.3.3 Transplant Listing 4.4 Immunosuppression 4.4.1 Common Immunosuppressive Agents 4.4.2 Adherence to Immunosuppression 4.4.3 Psychiatric and Psychological Reactions to Immunosuppression 4.5 Posttransplant Complications 4.5.1 Surgical Complications 4.5.2 Infections 4.5.3 Delayed Graft Function and Graft Loss 4.5.4 Posttransplant Delirium 4.5.5 Posttransplant Cognitive Impairment 4.6 Case Vignette Analysis 4.7 Key Takeaways References 5: Overview of Psychopharmacology Principles in Nephrology 5.1 Introduction 5.2 Case Vignette 5.3 Pharmacokinetics and the Kidney 5.3.1 Absorption 5.3.2 Distribution 5.3.3 Metabolism 5.3.4 Elimination 5.3.5 Acute Kidney Injury 5.3.6 Hemodialysis 5.3.7 Renal Transplantation 5.4 Recommendations for Dosage Adjustment of Psychotropic Drugs in Patients with Renal Impairment 5.4.1 Antipsychotics 5.4.2 Antidepressants 5.4.3 Mood Stabilizers 5.4.4 Benzodiazepines/Non-benzodiazepines 5.4.5 Cognitive Enhancers 5.5 Case Vignette Analysis 5.6 Key Takeaways References 6: Renal Toxicity of Psychotropic Medications 6.1 Introduction 6.2 Case Vignette 6.3 Lithium and Chronic Renal Impairment 6.3.1 Acute Lithium Toxicity 6.3.2 Diabetes Insipidus 6.3.3 Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) 6.4 Antidepressants 6.4.1 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) 6.5 Antipsychotics 6.6 Other Psychotropic Drugs 6.7 Case Vignette Analysis 6.8 Key Takeaways References 7: Overview of Psychotherapy Principles for Patients with Kidney Disease 7.1 Introduction 7.1.1 What Is Psychotherapy? 7.2 Relevance of Psychotherapy for Renal Patients 7.2.1 Common Presenting Concerns 7.2.2 Case Vignette: “One Thing After Another” 7.3 Biopsychosocial Model 7.3.1 Multidisciplinary Care 7.3.2 Patient Confidentiality in Multidisciplinary Care 7.3.3 Case Vignette: “One Thing After Another” (Continued) 7.4 Cognitive Behavioral Therapy 7.4.1 Efficacy of CBT with Kidney Patients 7.4.2 CBT Techniques 7.4.3 Considerations in Evaluating CBT Suitability 7.5 Applying CBT with Renal Patients 7.5.1 Self-Learning 7.5.2 Goal Setting 7.5.3 Case Conceptualization 7.5.4 Deciding on a Treatment Setting 7.5.5 Structure of CBT 7.5.6 Psychotherapist Flexibility 7.5.7 Symptom Monitoring 7.5.8 Motivational Enhancement 7.6 Challenges in Providing Psychotherapy to Kidney Patients 7.6.1 Strategies for Addressing Cognitive Impairments in Psychotherapy 7.7 Case Vignette Analysis: “One Thing After Another” 7.8 Key Takeaways References 8: Decisional Capacity Determinations in Psychonephrology 8.1 Introduction 8.2 Decisional Capacity: Medical Informed Consent 8.3 Decisional Capacity: Appointment of Surrogate 8.4 Dispositional Capacity 8.5 Neuropsychiatric Illnesses Leading to Impaired Decisional Capacity 8.5.1 Neurocognitive Disorders 8.5.2 Psychotic and Depressive Disorders 8.5.3 Specific Decisional Capacity Scenarios in Psychonephrology 8.6 Clinical Approaches to Decisional Capacity Determinations 8.7 Bioethical Approaches to Decisional Capacity Determinations in Psychonephrology 8.8 Case Vignettes and Analyses 8.8.1 Case Vignette 1: Request for Discharge Against Medical Advice 8.8.2 Case Vignette 2: Request for Changing Treatment to Renal Transplant 8.8.3 Case Vignette 3: Request for Hemodialysis Discontinuation 8.8.4 Case Vignette 4: Request for Other Organ Transplant 8.9 Key Takeaways References 9: Consultation-Liaison Psychiatry and Collaborative Care Models of the Patient with Renal Disease 9.1 Introduction 9.1.1 Case Vignette 1 9.2 The Chronic Care Model 9.2.1 Case Vignette 1 (Continued) 9.3 Collaborative Care and Consultation-Liaison Psychiatry 9.3.1 Case Vignette 2 9.3.2 Collaborative Care 9.3.3 Case Vignette 3 9.3.4 Consultation-Liaison Psychiatry 9.4 Collaborative Mental Health Care for CKD Patients 9.5 Case Vignette Analyses 9.5.1 Case Vignette 1 9.5.2 Case Vignette 2 9.5.3 Case Vignette 3 9.6 Key Takeaways References Part II: Common Psychiatric Presentations and Their Management in the Patient with Kidney Disease 10: Common Psychiatric Disorders in the Renal Patient 10.1 Introduction 10.2 Depressive Disorders 10.2.1 Case Vignette 1: The Depressed Patient 10.2.2 Case Vignette 1 Analysis 10.2.3 Epidemiology and Risk Factors 10.2.4 Diagnosis of Depressive Disorder in Renal Impairment 10.2.5 Outcomes and Prognostic Considerations 10.2.6 Treatment of ESRD as It Relates to Depressive Disorder 10.3 Anxiety Disorders 10.4 Trauma and Stressor-Related Disorders 10.4.1 Case Vignette 2: The Adjustment Disordered Patient 10.4.2 Case Vignette 2 Analysis 10.5 Bipolar Disorders 10.6 Psychotic Disorders 10.6.1 Case Vignette 3: The Psychotic Patient 10.6.2 Case Vignette 3 Analysis 10.7 Severe Mental Illness 10.8 Insomnia and Other Commonly Encountered Sleep Problems 10.9 Key Takeaways References 11: Substance Use Disorders and the Kidney 11.1 Introduction 11.2 Case Vignette: “A Rapid Crush” 11.3 Substance Use and the Kidney 11.3.1 Alcohols 11.3.2 Anabolic Androgenic Steroids 11.3.3 Cannabis 11.3.4 Dissociatives 11.3.5 Hallucinogens 11.3.6 Inhalants 11.3.7 Novel Psychoactive Substances 11.3.8 Opioids 11.3.9 Sedative-Hypnotics 11.3.10 Psychostimulants 11.3.11 Tobacco 11.4 Persons Who Inject Drugs 11.5 Substance Use Disorders and Renal Transplant 11.6 Substance-Induced Versus Other Comorbid Psychiatric Illness 11.7 Recovery Programs and Interventions 11.8 Case Vignette Analysis: “A Rapid Crush” 11.9 Key Takeaways References 12: Neurocognitive Ramifications of Renal Disease 12.1 Introduction and Epidemiology 12.2 Anatomic and Cognitive Correlates of CKD 12.2.1 Magnetic Resonance Imaging (MRI) Findings 12.2.2 Patterns of Cognitive Impairment in CKD 12.3 Pathophysiology of Cognitive Impairment in CKD 12.3.1 Delirium 12.3.1.1 Medication Toxicity Causing Delirium 12.3.2 Cerebrovascular Disease and Stroke 12.3.3 Other Pathophysiologic Mechanisms 12.3.3.1 Uremia 12.3.3.2 Endothelial Dysfunction 12.3.3.3 Neuroinflammation 12.3.3.4 Miscellaneous Factors Hyperhomocysteinemia Alterations in the Gut Microbiome The Effect of Anemia in CKD Sleep Disturbances 12.4 Transition to Renal Replacement Therapy and Effects on Cognitive Function 12.4.1 Delirium Induced by Hemodialysis 12.5 Cognitive Assessment in CKD 12.6 Case Vignette 12.7 Case Vignette Analysis 12.8 Key Takeaways References 13: Sexuality and Sexual Dysfunction in the Renal Patient 13.1 Introduction 13.2 Case Vignette 13.3 Sexuality and Kidney Disease 13.3.1 Gender and Sexual Orientation 13.4 Sexual Dysfunction in Women with Chronic Kidney Disease 13.5 Sexual Dysfunction in Men 13.6 Case Vignette Analysis 13.7 Key Takeaways References 14: Psychotoxicity of Immunomodulators: Corticosteroids, Mycophenolate, Tacrolimus, Cyclophosphamide, and Hydroxychloroquine 14.1 Corticosteroids 14.1.1 Overview 14.1.2 Range of Psychiatric Side Effects of Corticosteroids 14.1.3 Timing of Symptom Onset 14.1.4 Dose Dependence 14.1.5 Risk Factors 14.1.6 Pathophysiology 14.1.7 Treatment of Corticosteroid-Induced Psychiatric Reactions 14.1.8 Case Vignette: Corticosteroid-Induced Psychiatric Symptoms 14.2 Mycophenolate 14.3 Tacrolimus 14.3.1 Overview 14.3.2 Tacrolimus-Induced Catatonia 14.3.3 Tacrolimus-Induced Psychosis 14.3.4 Psychotoxic Effects of Tacrolimus in Pediatrics 14.3.5 Pathophysiology 14.3.6 Case Vignette 1: Tacrolimus-Induced Psychosis 14.3.7 Case Vignette 2: Tacrolimus-Induced Catatonia 14.4 Cyclophosphamide 14.5 Hydroxychloroquine 14.5.1 Overview 14.5.2 Case Vignette: Hydroxychloroquine-Induced Psychiatric Symptoms 14.6 Key Takeaways References 15: Psychological Aspects of Adaptation to Critical Care Nephrology, Dialysis, and Transplantation for the Patient and the Caregiver 15.1 Introduction 15.2 Case Vignette – “Brenda in Renal Crisis: Critical Care Nightmare” 15.3 Psychological Adjustment and Adaptation in Chronic Illness 15.4 Case Vignette – “Brenda and John in Recovery: Adjustment Post-critical Illness” 15.5 Qualitative Studies of Adjustment in Patients with End-Stage Renal Disease 15.6 Case Vignette – “Brenda and John in Dialysis: Back to the Grind” 15.7 Post-transplant Adjustment 15.8 Caregiver Roles and Adjustments 15.9 Case Vignette – “Brenda and John in Transplant: Walking into the Sunset – Not!” 15.10 Key Takeaways References 16: Palliative, End-of-Life, and Psychiatric Care of Patients with Advanced Renal Disease 16.1 Introduction 16.2 Case Vignette 16.3 Palliative Care Principles 16.4 Serious Illness Conversations Establish Patient Values and Goals 16.5 How to Approach Patients with CKD Stages 4 and 5 and Who Are Contemplating Initiating or Discontinuing Dialysis 16.6 Identifying Psychiatric Disorders in the Palliative Care Setting 16.6.1 Major Depression 16.6.2 Anxiety 16.6.3 Delirium 16.7 End-of-Life Symptom Management 16.7.1 Pain 16.7.2 Dyspnea 16.7.3 Delirium 16.7.4 Constipation 16.7.5 Secretions 16.8 Case Vignette Analysis 16.9 Key Takeaways References 17: Difficult Patient Encounters in Nephrology 17.1 Introduction 17.1.1 Case Vignette 1 17.2 Etiology 17.2.1 Patient Factors 17.2.1.1 Special Characteristics of Nephrology Patients 17.2.1.2 Personality Trait Domains 17.2.1.3 Case Vignette 2 17.2.1.4 Categorical Personality Disorders 17.2.2 Physician Factors 17.2.3 Case Vignette 3 17.3 Interventions 17.3.1 Strategies 17.4 Case Vignette Analyses 17.4.1 Case Vignette 1 Analysis 17.4.2 Case Vignette 2 Analysis 17.4.3 Case Vignette 3 Analysis 17.5 Key Takeaways References Part III: Special Issues in Psychonephrology 18: Chronic Kidney Disease and the Aging Population: Addressing Unmet Needs 18.1 Geriatric Syndromes in Patients with Chronic Kidney Disease 18.1.1 Frailty 18.1.2 Case Vignette 1 18.1.2.1 Case Vignette 1 Analysis 18.1.3 Case Vignette 2 18.1.3.1 Case Vignette 2 Analysis 18.1.4 Falls 18.1.5 Cognitive Impairment 18.2 Treatment Decisions in the Older Adult Patient 18.2.1 Life Expectancy of Older Adult Patients with ESKD 18.2.2 Hemodialysis vs. Peritoneal Dialysis 18.2.3 Vascular Access Considerations for Hemodialysis 18.2.4 Renal Transplant in Older Patients 18.2.5 Comprehensive Conservative Care 18.2.6 Case Vignette 3 18.2.6.1 Case Vignette 3 Analysis 18.3 Key Takeaways References 19: Physical Activity and Nutrition in Chronic Kidney Disease 19.1 Introduction 19.2 Case Vignette: “Samuel and Soccer” 19.3 Health, Wellness, and Quality of Life 19.4 Physical Activity, Exercise, and Fitness 19.4.1 Defining Key Terms 19.4.2 Physical Health Benefits of Exercise 19.4.3 Mental Health Benefits of Exercise 19.4.4 Physical Activity in Chronic Kidney Disease 19.4.5 Mitigating Health Risk in Exercise 19.4.6 Prescribing Physical Activity 19.5 Case Vignette: “Ana and Getting Going” 19.6 Nutrition and Dietary Management 19.6.1 Nutrition Science Basics 19.6.2 Nutrition for Physical and Mental Health 19.6.3 Nutrition and Cardiovascular Disease Risk 19.6.3.1 Diabetes Mellitus 19.6.3.2 Hypertension 19.6.3.3 Obesity 19.6.3.4 Lipids 19.6.4 Nutrition and Chronic Kidney Disease 19.6.4.1 Protein 19.6.4.2 Potassium 19.6.4.3 Phosphorus 19.6.4.4 Sodium 19.6.4.5 Fluid 19.6.4.6 Iron 19.6.4.7 Vitamin D 19.6.4.8 Calcium 19.6.4.9 Calories 19.7 Lifestyle Modification 19.7.1 Stages of Change 19.7.2 Patient- and Person-Centered Care 19.7.3 Motivational Interviewing 19.7.4 Interprofessional Teamwork 19.7.5 Chronic Disease Self-Management (CDSM) 19.8 Physician Advocacy 19.9 Vignette Analyses: “Samuel and Ana: Learning and Living” 19.10 Key Takeaways References 20: Gender Disparity and Women’s Health in Kidney Disease 20.1 Introduction 20.2 Gender Disparities in Chronic Kidney Disease 20.3 Gender Disparities in Hospitalizations and Mortality in Patients with ESKD 20.4 Gender Differences in Kidney Transplantation 20.5 Common Disorders and Psychosocial Concerns of Women with Kidney Disease 20.5.1 Depressive Disorders 20.5.2 Sexual Dysfunction 20.6 Pregnancy in CKD 20.7 Pregnancy in Kidney Transplant 20.8 Case Vignette 20.9 Case Vignette Analysis 20.10 Postpartum Care in Patients with CKD 20.11 Key Takeaways References 21: Cultural Considerations When Caring for Racial and Ethnic Minority Patients with End-Stage Renal Disease 21.1 The Basics of Chronic Kidney Disease and End-Stage Renal Disease 21.2 The Global Burden of CKD and ESRD 21.2.1 ESRD Prevalence Among Racial/Ethnic Minority Groups 21.2.2 Race and Ethnicity as Social Constructs 21.3 Renal Health Disparities Among Racial/Ethnic Minority Groups 21.3.1 The Social Determinants of Renal Health Among Racial/Ethnic Minority Groups 21.4 Case Vignette: “Lost in Translation” 21.5 Culture as a Determinant of Renal Health Among Racial/Ethnic Minority Groups 21.5.1 Ethnocentrism as a Barrier to Understanding the Impact of Culture on Renal Health 21.6 Establishing Cultural and Linguistic Competency in Renal Care 21.6.1 Clinician, Know Thyself: Individual-Level Strategies 21.6.2 Case Vignette Analysis: “Lost in Translation” 21.6.3 Through the Looking Glass: Organizational-Level Strategies 21.6.4 Challenging Eurocentrism in Medicine: Systemic-Level Strategies 21.7 Key Takeaways References 22: Occupation-Related Stress Affecting Physicians Caring for Patients with Renal Disease 22.1 The Basics of Burnout 22.1.1 Defining Burnout 22.1.2 Measuring Burnout 22.2 Burnout in the Medical Profession 22.2.1 A Leg Up on a Difficult Climb 22.3 Case Vignette: “A Slow Burn” 22.4 Burnout in the Nephrology Workforce 22.4.1 A Concerning Trend in Nephrology 22.5 Contributing Factors to Burnout in Nephrology 22.5.1 Individual Risk Factors 22.5.2 Organizational Risk Factors 22.5.3 The Impact of Moral Distress 22.5.4 Systemic Risk Factors 22.6 Case Vignette Analysis: “A Slow Burn” 22.7 The Consequences of Burnout in Nephrology 22.7.1 Individual Effects 22.7.2 Patient Care Effects 22.7.3 Health Systems Effects 22.8 Facilitating Physician Wellness in Nephrology 22.8.1 Redefining Physician Wellness 22.8.2 Boosting Physician Resilience 22.8.3 Driving Efficiency of Practice 22.8.4 Alleviating Moral Distress 22.8.5 Fostering a Culture of Wellness 22.9 Key Takeaways References 23: Modernizing Continuing Professional Development Using Social Media 23.1 Introduction 23.1.1 What Is SoMe? 23.1.2 Networked Learning 23.2 Case Vignette 23.3 Problems and Barriers to Using Social Media for Continuing Professional Development 23.3.1 Digital Identity Formation and Personal Bandwidth 23.3.2 Professionalism 23.3.3 Privacy 23.4 A “How To” Guide for Harnessing the Power of SoMe for Continuing Professional Development 23.4.1 Getting Started on Twitter 23.5 Building and Sustaining Cross-Disciplinary Virtual Communities of Practice 23.5.1 Bringing Disciplines Together 23.5.2 Creating an Online Rally Point 23.5.3 Sustainability and Structures 23.6 The Future 23.7 Case Vignette Analysis 23.8 Key Takeaways References 24: Psychonephrology of the Future: A Global Psychiatry and Nephrology Inter-specialty Curriculum for Training the Next Generation of Specialists 24.1 Introduction 24.2 Future Developments in Psychonephrology 24.2.1 Educational Milestones 24.2.2 Educational Models 24.3 Future Directions and Fostering Collaboration 24.4 Key Takeaways References Index