Chronic Peritoneal Dialysis Patients Diagnosed with Clinical Depression: Results of Pharmacologic Therapy

Diane Wuerth, H. Susan, Finkelstein, Alan S. Kliger, Fredric O. Finkelstein

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Depression has been documented as the most frequently encountered psychological problem in end-stage renal disease (ESRD) patients and has been correlated with both mortality and morbidity in these patients. Previous work by our group has shown that clinical depression is treatable with psychotropic medications in these patients, but that only a limited number of ESRD patients with depression will successfully complete a course of pharmacologic therapy. From July 1997 to October 2002, all chronic peritoneal dialysis (PD) patients in our facility were encouraged to be screened for depression utilizing the self-administered Beck Depression Inventory (BDI) questionnaire. Based on previous work, a score ≥11 on this questionnaire was used to indicate a possible diagnosis of clinical depression; patients with BDI scores ≥11 were encouraged to complete a more formal evaluation for the presence of clinical depression. A total of 320 BDI questionnaires were completed during the study period: 134 patients. (42%) scored ≥11 on the BDI, 69 of the 134 patients (51%) with BDI scores ≥11 agreed to further evaluation. Sixty of these 69 patients (87%) were diagnosed with clinical depression based on scores ≥18 on the Hamilton Depression Scale and standard Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Forty-four patients with clinical depression agreed to pharmacologic treatment. However, only 23 of the 44 patients (52%) successfully completed a 12-week course of drug therapy. Two unit social work reviewers systematically reviewed the records of these 21 patients who did not complete therapy and assessed the reasons for their inability to complete treatment. Reasons identified included eight patients who experienced acute medical problems, three who were active substance abusers, and two who reported medication side effects. The remaining eight patients who did not complete the 12 weeks of therapy were examined by applying the axis 1 and axis 2 DSM-IV criteria. Axis 1 is used to diagnose clinical disorders and axis 2 is used to diagnose personality disorders. While all these patients met the DSM-IV axis 1 criteria for clinical depression, eight of these patients met axis 2 criteria for personality disorders; five patients had borderline personality disorders, one had a narcissistic personality disorder, one had a factitious disorder, and one had features of avoidant personality disorder. While some chronic PD patients can be successfully treated for clinical depression with psychotropic medication prescribed by the dialysis medical team, not all patients will agree to be evaluated for clinical depression and accept pharmacologic treatment. Others cannot or will not complete treatment when additional psychiatric disorders exist. These patients may require additional intervention when diagnosed with clinical depression and a personality disorder. Further trials are warranted.

Original languageEnglish (US)
Pages (from-to)424-427
Number of pages4
JournalSeminars in Dialysis
Volume16
Issue number6
DOIs
StatePublished - Nov 2003

Fingerprint

Peritoneal Dialysis
Depression
Personality Disorders
Therapeutics
Diagnostic and Statistical Manual of Mental Disorders
Equipment and Supplies
Chronic Kidney Failure
Factitious Disorders
Borderline Personality Disorder

ASJC Scopus subject areas

  • Nephrology

Cite this

Chronic Peritoneal Dialysis Patients Diagnosed with Clinical Depression : Results of Pharmacologic Therapy. / Wuerth, Diane; Susan, H.; Finkelstein; Kliger, Alan S.; Finkelstein, Fredric O.

In: Seminars in Dialysis, Vol. 16, No. 6, 11.2003, p. 424-427.

Research output: Contribution to journalArticle

Wuerth, Diane ; Susan, H. ; Finkelstein ; Kliger, Alan S. ; Finkelstein, Fredric O. / Chronic Peritoneal Dialysis Patients Diagnosed with Clinical Depression : Results of Pharmacologic Therapy. In: Seminars in Dialysis. 2003 ; Vol. 16, No. 6. pp. 424-427.
@article{f3a4b4493afc49aea16322f99e6baa05,
title = "Chronic Peritoneal Dialysis Patients Diagnosed with Clinical Depression: Results of Pharmacologic Therapy",
abstract = "Depression has been documented as the most frequently encountered psychological problem in end-stage renal disease (ESRD) patients and has been correlated with both mortality and morbidity in these patients. Previous work by our group has shown that clinical depression is treatable with psychotropic medications in these patients, but that only a limited number of ESRD patients with depression will successfully complete a course of pharmacologic therapy. From July 1997 to October 2002, all chronic peritoneal dialysis (PD) patients in our facility were encouraged to be screened for depression utilizing the self-administered Beck Depression Inventory (BDI) questionnaire. Based on previous work, a score ≥11 on this questionnaire was used to indicate a possible diagnosis of clinical depression; patients with BDI scores ≥11 were encouraged to complete a more formal evaluation for the presence of clinical depression. A total of 320 BDI questionnaires were completed during the study period: 134 patients. (42{\%}) scored ≥11 on the BDI, 69 of the 134 patients (51{\%}) with BDI scores ≥11 agreed to further evaluation. Sixty of these 69 patients (87{\%}) were diagnosed with clinical depression based on scores ≥18 on the Hamilton Depression Scale and standard Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Forty-four patients with clinical depression agreed to pharmacologic treatment. However, only 23 of the 44 patients (52{\%}) successfully completed a 12-week course of drug therapy. Two unit social work reviewers systematically reviewed the records of these 21 patients who did not complete therapy and assessed the reasons for their inability to complete treatment. Reasons identified included eight patients who experienced acute medical problems, three who were active substance abusers, and two who reported medication side effects. The remaining eight patients who did not complete the 12 weeks of therapy were examined by applying the axis 1 and axis 2 DSM-IV criteria. Axis 1 is used to diagnose clinical disorders and axis 2 is used to diagnose personality disorders. While all these patients met the DSM-IV axis 1 criteria for clinical depression, eight of these patients met axis 2 criteria for personality disorders; five patients had borderline personality disorders, one had a narcissistic personality disorder, one had a factitious disorder, and one had features of avoidant personality disorder. While some chronic PD patients can be successfully treated for clinical depression with psychotropic medication prescribed by the dialysis medical team, not all patients will agree to be evaluated for clinical depression and accept pharmacologic treatment. Others cannot or will not complete treatment when additional psychiatric disorders exist. These patients may require additional intervention when diagnosed with clinical depression and a personality disorder. Further trials are warranted.",
author = "Diane Wuerth and H. Susan and Finkelstein and Kliger, {Alan S.} and Finkelstein, {Fredric O.}",
year = "2003",
month = "11",
doi = "10.1046/j.1525-139X.2003.16094.x",
language = "English (US)",
volume = "16",
pages = "424--427",
journal = "Seminars in Dialysis",
issn = "0894-0959",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Chronic Peritoneal Dialysis Patients Diagnosed with Clinical Depression

T2 - Results of Pharmacologic Therapy

AU - Wuerth, Diane

AU - Susan, H.

AU - Finkelstein,

AU - Kliger, Alan S.

AU - Finkelstein, Fredric O.

PY - 2003/11

Y1 - 2003/11

N2 - Depression has been documented as the most frequently encountered psychological problem in end-stage renal disease (ESRD) patients and has been correlated with both mortality and morbidity in these patients. Previous work by our group has shown that clinical depression is treatable with psychotropic medications in these patients, but that only a limited number of ESRD patients with depression will successfully complete a course of pharmacologic therapy. From July 1997 to October 2002, all chronic peritoneal dialysis (PD) patients in our facility were encouraged to be screened for depression utilizing the self-administered Beck Depression Inventory (BDI) questionnaire. Based on previous work, a score ≥11 on this questionnaire was used to indicate a possible diagnosis of clinical depression; patients with BDI scores ≥11 were encouraged to complete a more formal evaluation for the presence of clinical depression. A total of 320 BDI questionnaires were completed during the study period: 134 patients. (42%) scored ≥11 on the BDI, 69 of the 134 patients (51%) with BDI scores ≥11 agreed to further evaluation. Sixty of these 69 patients (87%) were diagnosed with clinical depression based on scores ≥18 on the Hamilton Depression Scale and standard Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Forty-four patients with clinical depression agreed to pharmacologic treatment. However, only 23 of the 44 patients (52%) successfully completed a 12-week course of drug therapy. Two unit social work reviewers systematically reviewed the records of these 21 patients who did not complete therapy and assessed the reasons for their inability to complete treatment. Reasons identified included eight patients who experienced acute medical problems, three who were active substance abusers, and two who reported medication side effects. The remaining eight patients who did not complete the 12 weeks of therapy were examined by applying the axis 1 and axis 2 DSM-IV criteria. Axis 1 is used to diagnose clinical disorders and axis 2 is used to diagnose personality disorders. While all these patients met the DSM-IV axis 1 criteria for clinical depression, eight of these patients met axis 2 criteria for personality disorders; five patients had borderline personality disorders, one had a narcissistic personality disorder, one had a factitious disorder, and one had features of avoidant personality disorder. While some chronic PD patients can be successfully treated for clinical depression with psychotropic medication prescribed by the dialysis medical team, not all patients will agree to be evaluated for clinical depression and accept pharmacologic treatment. Others cannot or will not complete treatment when additional psychiatric disorders exist. These patients may require additional intervention when diagnosed with clinical depression and a personality disorder. Further trials are warranted.

AB - Depression has been documented as the most frequently encountered psychological problem in end-stage renal disease (ESRD) patients and has been correlated with both mortality and morbidity in these patients. Previous work by our group has shown that clinical depression is treatable with psychotropic medications in these patients, but that only a limited number of ESRD patients with depression will successfully complete a course of pharmacologic therapy. From July 1997 to October 2002, all chronic peritoneal dialysis (PD) patients in our facility were encouraged to be screened for depression utilizing the self-administered Beck Depression Inventory (BDI) questionnaire. Based on previous work, a score ≥11 on this questionnaire was used to indicate a possible diagnosis of clinical depression; patients with BDI scores ≥11 were encouraged to complete a more formal evaluation for the presence of clinical depression. A total of 320 BDI questionnaires were completed during the study period: 134 patients. (42%) scored ≥11 on the BDI, 69 of the 134 patients (51%) with BDI scores ≥11 agreed to further evaluation. Sixty of these 69 patients (87%) were diagnosed with clinical depression based on scores ≥18 on the Hamilton Depression Scale and standard Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Forty-four patients with clinical depression agreed to pharmacologic treatment. However, only 23 of the 44 patients (52%) successfully completed a 12-week course of drug therapy. Two unit social work reviewers systematically reviewed the records of these 21 patients who did not complete therapy and assessed the reasons for their inability to complete treatment. Reasons identified included eight patients who experienced acute medical problems, three who were active substance abusers, and two who reported medication side effects. The remaining eight patients who did not complete the 12 weeks of therapy were examined by applying the axis 1 and axis 2 DSM-IV criteria. Axis 1 is used to diagnose clinical disorders and axis 2 is used to diagnose personality disorders. While all these patients met the DSM-IV axis 1 criteria for clinical depression, eight of these patients met axis 2 criteria for personality disorders; five patients had borderline personality disorders, one had a narcissistic personality disorder, one had a factitious disorder, and one had features of avoidant personality disorder. While some chronic PD patients can be successfully treated for clinical depression with psychotropic medication prescribed by the dialysis medical team, not all patients will agree to be evaluated for clinical depression and accept pharmacologic treatment. Others cannot or will not complete treatment when additional psychiatric disorders exist. These patients may require additional intervention when diagnosed with clinical depression and a personality disorder. Further trials are warranted.

UR - http://www.scopus.com/inward/record.url?scp=0347479182&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0347479182&partnerID=8YFLogxK

U2 - 10.1046/j.1525-139X.2003.16094.x

DO - 10.1046/j.1525-139X.2003.16094.x

M3 - Article

C2 - 14629600

AN - SCOPUS:0347479182

VL - 16

SP - 424

EP - 427

JO - Seminars in Dialysis

JF - Seminars in Dialysis

SN - 0894-0959

IS - 6

ER -