Treating bipolar disorder in patients with renal failure having haemodialysis: two case reports

Maneesh Gupta,Srinivas Annadatha

doi:10.1186/1745-0179-4-21

Abstract

BackgroundThere is little published guideline or evidence on treating bipolar affective disorder in patients with renal failure having haemodialysis.CaseWe present two patients with bipolar affective disorder with renal failure having haemodialysis. We used lorazepam in one patient to manage the immediate risk of non-engagement with dialysis. Risperidone was added in the second patient for managing psychotic symptoms. Valproate was started as a mood stabiliser and titrated upwards for long-term management of the illness.ConclusionWe discuss the similarities in the two cases and the care plan we used to manage them.

Highlights

There is little published guideline or evidence on treating bipolar affective disorder in patients with renal failure having haemodialysis.Case: We present two patients with bipolar affective disorder with renal failure having haemodialysis
Two decades back chronic renal failure was almost a death knell for patients but today haemodialysis has led to increased life expectancy and increased expectations of patients from their clinicians
We present two patients both admitted to an inpatient psychiatric unit, with thrice-weekly haemodialysis and present the treatment challenges and the different needs of these individuals

Summary

Background

Improvements in life expectancy and quality of life in people with chronic medical disorders means new challenges are being created for clinicians. Over these years she had been receiving lofepramine 140 mg as an antidepressant for emergent symptoms of grief, inability to cope and tiredness Her renal failure led to a reduction of the dose to 70 mg a day. Valproate was reduced to 250 mg bd, though the reasons for this are not clear She had not needed hospitalization in a psychiatric unit for over 14 years. She presented to accident and emergency (A&E) three times within a week with different complaints and physical symptoms, feeling stressed and being fed up of dialysis. After four days valproate was increased to 1250 mg daily She improved within two weeks, became less demanding, calm at dialysis and agreeing to be in hospital

Discussion

Conclusion