Abstract
The aim of the study was to identify the terror of death and anxiety level in patients with end-stage renal disease receiving renal replacement therapy using chronic hemodialysis (HD) and to evaluate the impact of patients' psychological status on medical staff, selection of basic methods of psychotherapeutic care for patients in this category. We involved 37 patients, aged 33-72 years (mean, 45.6 ± 3.8 years). The duration of chronic HD ranged from 8 months to 10 years, with an average of 4.6 years. All the patients had a stable nutritional status, HD regimen and drug therapy for at least 3 months. To diagnose the psychological state of patients we used: the scale of self-assessment of the level of situational and personal anxiety (Spielberger-Hanin’s Scale), personal questionnaire for changes at the onset of HD therapy, elements of a clinical interview, image apperception test (simplified version of Thematic apperception test., Bechterev’s Institute Personal Questionnaire for Diagnosis of Type of Illness (LOBI), Locus of control and personal changes after initiation of HD therapy.
 We found that the: adaptation of the patient to HD therapy is complicated due to the high degree of anxiety and maladaptive terror of death, which reduce the patient’s quality of life. The HD procedure increases the level of situational anxiety and requires psycho-correction. HD therapy requires activation of the patient's psychological protection mechanisms, since the dominant protective mechanisms of the psyche in this type of substitution treatment are displacement and negation. The inflexible and rigid use of the latter provokes maladaptive reactions when interacting with healthcare providers, a non-constructive approach to lifestyle choices, work-rest regime, and diet. Patients with a maladaptive mode of adjustment to HD therapy require psychotherapy assistance. There is a need to monitor the psychological status of not only patients, but also medical staff, which due to the specificity of the contingent increases the level of contingent own terror of death. Doctors of HD units require participation in mutual support groups.
Highlights
Treatment of patients with chronic renal insufficiency using chronic hemodialysis (HD) is a potent psycho-traumatic factor and requires adequate mechanisms of defense (McClellan et al, 1991)
We found that the: adaptation of the patient to HD therapy is complicated due to the high degree of anxiety and maladaptive terror of death, which reduce the patient’s quality of life
There is a need to monitor the psychological status of patients, and medical staff, which due to the specificity of the contingent increases the level of contingent own terror of death
Summary
Treatment of patients with chronic renal insufficiency using chronic hemodialysis (HD) is a potent psycho-traumatic factor and requires adequate mechanisms of defense (McClellan et al, 1991). The psycho-traumatic factors include: regular stay of patients in the environment with a heightened level of morbidity and emergence of intrapersonal conflict due to dependence on HD (El Filali et al, 2017). Functional status and quality of life are strong independent risk factors for subsequent mortality in new dialysis patients (McClellan et al, 1991). The presence of mental disorders significantly reduces the quality of life of such patients, it adversely affects their somatic condition and provokes the enhancement of psychological disorders in medical staff in the process of the interpersonal relationship (Lee & King, 2014).
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