Chronic Mental Disorders Research Articles

NKCC1 to KCC2 mRNA Ratio in Schizophrenia and Its Psychopathology: a Case-Control Study.

Schizophrenia (SCZ) is a debilitating, destructive, and chronic mental disorder and affects approximately one percent of the human population. Diagnosis in psychiatry is based on the patient's descriptions of his/her symptoms, interviewer's observations, history of disorder over time, and response to treatment. All of these data measure phenotype-based functions. But it appears that accurate diagnosis of such a complex disorder must be based on valid and reliable factors. In the present study, gene selection was based on the possible role of γ-aminobutyric acid (GABA) in psychopathology of SCZ and expression in blood. We evaluated the association of Na+-K+-Cl- co-transporter 1 (NKCC1) and K+-Cl- co-transporter 2 (KCC2) genes' messenger ribonucleic acid (mRNA) levels, and also the NKCC1/KCC2 ratio with positive and negative syndrome scale (PANSS) and brief psychiatric rating scale (BPRS) scores in an SCZ group. By using real-time PCR (RT-PCR), the present study is the first attempt to explore levels of NKCC1 and KCC2 expression at mRNA level and their relative expression in human peripheral blood of patients with SCZ. Our results showed that the NKCC1 to KCC2 mRNA ratio is significantly increased (but based on the delta cycle of threshold [∆Ct] is significantly lower) in the total sample of cases rather than controls (p = 0.045) and also higher in male sample cases rather than male controls (p = 0.016). In female samples, we found a trend toward a significant effect between the case and control participants (p = 0.075). We also found statistically significant association between mRNA of NKCC1 and KCC2 genes and NKCC1/KCC2 mRNA ratio with the positive and negative syndrome scale (PANSS) and brief psychiatric rating scale (BPRS) scores.

Alternative Therapy of Psychosis: Potential Phytochemicals and Drug Targets in the Management of Schizophrenia.

Schizophrenia is a chronic mental and behavioral disorder characterized by clusters of symptoms including hallucinations, delusions, disorganized thoughts and social withdrawal. It is mainly contributed by defects in dopamine, glutamate, cholinergic and serotonergic pathways, genetic and environmental factors, prenatal infections, oxidative stress, immune system activation and inflammation. Management of schizophrenia is usually carried out with typical and atypical antipsychotics, but it yields modest benefits with a diversity of side effects. Therefore, the current study was designed to determine the phytochemicals as new drug candidates for treatment and management of schizophrenia. These phytochemicals alter and affect neurotransmission, cell signaling pathways, endocannabinoid receptors, neuro-inflammation, activation of immune system and status of oxidative stress. Phytochemicals exhibiting anti-schizophrenic activity are mostly flavonoids, polyphenols, alkaloids, terpenoids, terpenes, polypropanoids, lactones and glycosides. However, well-designed clinical trials are consequently required to investigate potential protective effect and therapeutic benefits of these phytochemicals against schizophrenia.

Transition-oriented patient education program for adolescents and young adults with ADHD

Transition-oriented patient education program for adolescents and young adults with ADHD Abstract. Background: The transition from child- to adult-centered treatment includes numerous challenges in the treatment of chronic disorders. This process can be further complicated by disease-specific characteristics of attention-deficit/hyperactivity disorders (ADHD). This secondary analysis evaluated a transition workshop in individuals with ADHD. Methods: In total, 56 adolescents and young adults with ADHD (age M = 17.3 years, SD = 1.1; 17.9 % female) and their parents were quasi-randomly assigned to a control group (CG, n = 28) or an intervention group (IG, n = 28). The CG received regular medical care, whereas the IG additionally participated in a one-and-a-half-day transition workshop (ModuS-T). Before and 4 weeks after the intervention, transition competence was assessed with the Transition Competence Scale (TKS), patient activation with the Patient Activation Measure 13 for Adolescents (PAM® 13), and satisfaction with care with the Patient Satisfaction Questionnaire (ZUF-8). Results: The IG showed significantly improved transition competence (p ≤ .001) compared to the CG. There was no significant intervention effect in terms of patient activation (p = .194). Overall, the IG was highly satisfied with the workshop. Discussion: To date, transition workshops have been evaluated predominantly in individuals with chronic somatic disorders. This secondary analysis indicates that a generic workshop is also associated with improved transition competence and high satisfaction in individuals with chronic mental disorders. The integration of such approaches into routine care needs to be discussed.

THE INFLUENCED FACTORS OF SPIRITUAL WELL-BEING: A SYSTEMATIC REVIEW

Well-being in essence is not just material or physical prosperity, but how each individual gets the opportunity to develop his full potential, including spirituality. This study aims to explore the factors that influence spiritual well-being. The method used in this research is a systematic review. The findings of this study are factors that affect spiritual well-being including: mental health, spiritual coping, life satisfaction, hope, primary emotions, mindfulness, self-compassion, perceived social support, quality of life, adjustment to chronic diseases, psychological disorders, psychological well-being, and psychological resilience.

Kronik Ruhsal Hastalıklarda Bakım Veren Yükünün Gözden Geçirilmesi

Review of Caregiver Burden in Chronic Mental Illnesses ABSTRACT Objective: This systematic study adimse at reviewing the research conducted to determine the burden of caregivers and related conditions among individuals with chronic diseases in our country between 2007 and 2019. Materials and Methods: The research was carried out between April 2019 and May 2019. In the study, Turkish Medline, Turkish Psychiatry Index, YÖK National Thesis Center, Turkish Medical Database and Pubmed databases were used. Of the 812 studies included in the study, 26 studies included in the research area were included in the study. Results: The reviewed studies were generally descriptive and carried out with caregivers of schizophrenia patients. In these studies, various measurement tools were used. It was found that the load perceptions of the caregivers were moderate and/or severe, and detected this perception was affected by different variables. Conclusion: In our country, the number of experimental and qualitative studies should be increased in order to determine caregiver burden in chronic mental diseases.. Keywords: Caregiver burden; psychiatric diagnosis; chronic mental disorder

Unhealthy Dieting During the COVID-19 Pandemic: An Opinion Regarding the Harmful Effects on Brain Health.

Since 2020, the world has been suffering from a pandemic that has affected thousands of people regardless of socio-economic conditions, forcing the population to adopt different strategies to prevent and control the advance of the disease, one of which is social distancing. Even though social distancing is a safe strategy to reduce the spread of COVID-19, it is also the cause of a rising sedentary behavior. This behavior develops an excess of fat tissue that leads to metabolic and inflammatory disruption related to chronic diseases and mental health disorders, such as anxiety, depression, and sleep issues. Furthermore, the adoption of dietary patterns involving the consumption of ultra-processed foods, higher in fats and sugars, and the reduction of fresh and healthy foods may play a role in the progress of the disease. In this perspective, we will discuss how an unhealthy diet can affect brain function and, consequently, be a risk factor for mental health diseases.

Potensi interaksi obat pada pasien skizofrenia di Rumah Sakit Jiwa Mutiara Sukma tahun 2020

Schizophrenia is a chronic mental disorder characterized by distortions in thinking and behavior. Schizophrenic patients receive antipsychotic therapy (main) and non-antipsychotic (supportive) for a long time. Prescription drugs are given either single or in combination, that can possible for drug interactions. This study objective to determine the potential drug-drug interactions in schizophrenic patients. The design of this study was cross-sectional with purposive sampling technique. The data used is secondary data from the medical records of inpatient schizophrenia patients at the Mutiara Sukma Mental Hospital NTB in 2020 with a retrospective method. The sample data obtained were 109 medical records. The results showed that there were 82,2% of drug interaction cases, namely the combination of risperodone and lorazepam. The number of major interaction cases is 24,2%, moderate is 72,1% and minor is 3,6%. The high incidence of drug interactions in schizophrenic patients requires closely monitored.

“It’s what makes us unique”: Indigenous Australian perspectives on genetics research to improve comorbid mental and chronic disease outcomes

Background The role of personalized treatment approaches, including those based on genetic testing, are increasingly enabling informed decision-making to improve health outcomes. Research involving Indigenous Australians has been lagging behind, although this population experiences a higher prevalence of chronic disease and mental health disorders. Methods Using community-based participatory research principles, this study purposefully interviewed participants with a diagnosed common mental disorder and a comorbid chronic disease condition. This was an inductive thematic analysis on semi-structured interviews with consenting participants (n = 48). Common themes and analytical domains were identified that provided a semantic understanding shared by participants. Results Five emerging themes were identified, primarily focusing on: (1) The perceptions and understanding of genetics research; (2) culturally appropriate conduct of genetics research; (3) the role of indigenous-led genetics research; (4) future prospects of genetics research; and (5) the importance of genetics research for patients with mental and physical health comorbidities. Conclusion Indigenous Australians are under-represented in pharmacogenomics research despite well-documented epidemiological research demonstrating that Indigenous people globally experience greater risk of developing certain chronic diseases and more severe disease progression. Positive outcomes from this study highlight the importance of not only involving Indigenous participants, but providing leadership and governance opportunities for future genetics research.

ANALYSIS OF SOCIAL COMPETENCE OF CHILDREN AND ADOLESCENTS WITH MENTAL DISORDERS

Abstract. Relevance: the need to analyze the social incompetence of patients is closely related to the issues of habilitation and rehabilitation. Social incompetence, as a rule, is associated with underdevelopment or loss of skills necessary for life. Early detection of insufficiency of skills allows timely start to develop and implement individual socio-rehabilitation programs. Aim: to analyze the features of social functioning and to identify the underdevelopment of basic life skills in adolescents and adolescents who have suffered from various mental illnesses since childhood. Materials and methods. 1750 patients with various mental disorders were examined using the methodology developed in the Department for the Study of Problems of Adolescent Psychiatry FSBSI «The Mental Health Research Centre» - «Registration card of social skills and abilities of adolescents suffering from chronic mental disorders». The material of the study was patients of childhood and adolescence who applied on an outpatient basis to neuropsychiatric dispensaries in Moscow. Results: the methodology allowed us to comparatively assess the structure of skills deficit. Among the most maladjusted were patients with severe mental retardation. Patients with schizophrenia showed a significant variation in the level of social adaptation, individual preferences in the implementation of skills, they noted a dissociation between the presence and implementation of skills, a dissociation between educational skills and self-service and everyday skills. The severity of social failure depended on the severity of mental pathology, on its nosology, the well-being and adequacy of the social environment, and the type of upbringing in the family. Conclusions: the technique proved to be useful in structuring work with adolescents. It can be used both in diagnosing life skills deficiencies and in planning social rehabilitation events.

The Portrait of Cyberchondria-A Cross-Sectional Online Study on Factors Related to Health Anxiety and Cyberchondria in Polish Population during SARS-CoV-2 Pandemic.

The SARS-CoV-2 pandemic has served as a magnifying glass for cyberchondria, while the internet emerged as one of the main sources of medical information and support. The core ambition of this study was to estimate the level of cyberchondria and describe the socio-demographic, clinical and pandemic-related factors affecting its severity amid the SARS-CoV-2 pandemic. A cross-sectional study was performed between 16 May 2020 and 29 December 2020 in Poland within a sample of 538 adult internet users. The online survey tool included a Polish adaptation of the Cyberchondria Severity Scale (CSS-PL) and the Short Health Anxiety Inventory (SHAI), complemented with a set of questions covering sociodemographic, clinical and pandemic-related factors. Participants were clustered according to severity of health anxiety and cyberchondria symptoms. The performed binary logistic regression indicated professional inactivity, having a chronic mental disorder and subjectively limited access to healthcare due to COVID-19 to be key determinants of severe health anxiety and cyberchondria. Cyberchondria might be a remarkable public health issue as large proportion of respondents from the analyzed sample population of internet users met the criteria for severe symptoms. Key determinants of intense cyberchondria corresponded with employment stability, mental resilience and accessibility of healthcare services, which could be greatly challenged amid the pandemic.

Characterizing posttraumatic stress disorder in primary care using electronic medical records: a retrospective cohort study.

Posttraumatic stress disorder (PTSD) is a chronic mental health disorder associated with significant morbidity and economic cost. Primary care providers are frequently involved in the ongoing management of patients experiencing PTSD, as well as related comorbid conditions. Despite recognized need to enhance PTSD management in primary care settings, knowledge regarding its prevalence in these settings is limited. To apply a validated case definition of PTSD to electronic medical records (EMRs) of family physicians and nurse practitioners participating in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Retrospective cross-sectional study. This study accessed de-identified EMR from 1,574 primary care providers participating in the CPCSSN. The study population included all patients with at least one visit to a primary care provider participating in the CPCSSN between January 1, 2017 and December 31, 2019 (N = 689,301). We identified patients with PTSD and described associations between PTSD and patient characteristics (including sex, age, geography, depression, anxiety, medical comorbidities, substance use and social and material deprivation) using multivariable logistic regression models. Among the 689,301 patients meeting inclusion criteria, 8,213 (1.2%) had a diagnosis of PTSD. Patients with PTSD were significantly more likely to reside in an urban location (84.9% vs. 80.4%; p-value <.0001) and have one or more comorbid conditions (90.8% vs. 70.2%; p-value <.0001). On multivariable logistic regression analysis, patients with depression (OR 4.8; 95%CI 4.6-5.1) and anxiety (OR 2.2; 95%CI 2.1-2.3) had increased odds of having PTSD compared to patients without depression or anxiety. Patients with alcohol (OR 1.8; 95%CI 1.6-1.9) and drug (OR 3.1; 95%CI 2.9-3.3) use disorders had significantly higher odds of PTSD compared to patients without these disorders. Patients in the most deprived neighborhoods based on census data had 4.2 times higher odds of have PTSD (95%CI 3.2-5.43) compared to patients in the least deprived areas. This is the first study to describe PTSD prevalence in a large Canadian sample of primary care patients using an EMR-based case definition. Characterizing patients with PTSD in primary care may improve disease surveillance and inform the interdisciplinary care required to manage PTSD symptoms.

The Adapted Questionnaire of Work Motivation for People Living with Chronic Mental Disorders” (CAMT): Validation in Mexican People with Bipolar Disorder

The Adapted Questionnaire of Work Motivation for People Living with Chronic Mental Disorders” (CAMT): Validation in Mexican People with Bipolar Disorder

Pattern of Antipsychotics in Schizophrenia Outpatients at Lampung Province Mental Hospital

Schizophrenia as a chronic mental disorder, has increased in number in the last three decades DALYs (Disability Adjusted Life Years). Antipsychotics have been the mainstay of treatment. The use of combinations of typical/atipycal antipsychotic active substances is very often done. The purpose of this study was to look at patient characteristics and clinical characteristics including the number and type of antipsychotic combinations. This research is descriptive research with a quantitative and cross-sectional approach. Data age, gender, duration of illness, financing status, number of drugs, and the name of the antipsychotic used were taken from medical records and prescription sheets from 207 outpatients diagnosed with schizophrenia. The data was then processed and analyzed using univariate analysis. Outpatient schizophrenia patients were dominated by 62.8% male, aged 26-35 years 32.4%, duration of illness more than 12 months was 92.3%, 82.8% used health insurance, the average number of drugs prescribed was 3.5 drugs. The combination with two antipsychotics was 58%. The atypical-typical combinations (30.9%) were higher with the most risperidone-clozapine. Typical-typical combinations (19.3%) included chlorpromazine-haloperidol, trifluoperazine-chlorpromazine. Atypical-atypical combinations include risperidone-clozapine. The combination of three antipsychotics reached 7.7%. The conclusion of this study shows that the combination of antipsychotics is widely used in the treatment of schizophrenia, with two types of antipsychotics being the most widely used. The combination of risperidone-chlorpromazine was the most common at 21.7%.

Dysregulated affective arousal regulates reward-based decision making in patients with schizophrenia: an integrated study

Schizophrenia is a chronic and severe mental disorder. Dysregulated decision-making and affective processing have been implicated in patients with schizophrenia (SZ) and have significant impacts on their cognitive and social functions. However, little is known about how affective arousal influences reward-based decision-making in SZ. Taking advantage of a two-choice probabilistic gambling task and utilizing three facial expressions as affective primes (i.e., neutral, angry, and happy conditions) in each trial, we investigated how affective arousal influences reward-related choice based on behavioral, model fitting, and feedback-related negativity (FRN) data in 38 SZ and 26 healthy controls (CTRL). We also correlated our measurements with patients’ symptom severity. Compared with the CTRL group, SZ expressed blunted responses to angry facial primes. They had lower total game scores and displayed more maladaptive choice strategies (i.e., less win-stay and more lose-shift) and errors in monitoring rewards. Model fitting results revealed that the SZ group had a higher learning rate and lower choice consistency, especially in the happy condition. Brain activity data further indicated that SZ had smaller amplitudes of FRN than their controls in the angry and happy conditions. Importantly, the SZ group exhibited attenuated affective influence on decision-making, and their impairments in decision-making were only correlated with their clinical symptoms in the angry condition. Our findings imply the affective processing is dysregulated in SZ and it is selectively involved in the regulation of choice strategies, choice behaviors, and FRN in SZ, which lead to impairments in reward-related decision-making, especially in the angry condition.

Associations Between Outcome Resilience and Sociodemographic Factors, Childhood Trauma, Personality Dimensions and Self-Rated Health in Middle-Aged Adults

BackgroundWe examined how sociodemographic factors, childhood trauma, personality dimensions, and self-rated health were associated with outcome resilience and how different stressors influenced depressive symptoms.MethodsAn outcome resilience score for 213 adults was derived by means of a residualization approach. Associations between outcome resilience and sociodemographic and personality factors were evaluated using linear regression. In addition, associations between log-transformed depressive symptoms and the stressors were analyzed using multiple linear regression. A Pearson correlation coefficient between self-rated health and outcome resilience was also computed.ResultsHigher neuroticism was negatively and higher conscientiousness was positively associated with outcome resilience. Better self-rated health was associated with higher outcome resilience. Somatic disease events and onset of chronic mental disorders were associated with more depressive symptoms.ConclusionsOutcome resilience was significantly related to neuroticism, conscientiousness, and self-rated health. Strong associations between depressive symptoms and the stressors somatic disease event, and chronic mental disorder were observed.

Coping Strategies and Burden Dimensions of Family Caregivers for People Diagnosed with Obsessive-Compulsive Disorder.

(1) Background: Obsessive–compulsive disorder (OCD) is a chronic mental disorder that can be a source of emotional, financial and/or social burden for family caregivers. Few studies have investigated family caregiving for patients diagnosed with OCD in relation to the coping strategies being used from a theoretical perspective. This study evaluated the burden and coping strategies of family caregivers for people diagnosed with OCD. (2) Methods: A cross-sectional study was conducted, in which 123 participants diagnosed with OCD and their caregivers were surveyed using three types of scales: obsessive–compulsive scale; coping scale; and burden scale. (3) Results: Of the participants with OCD and their caregivers, 53% and 31% were male and 47% and 69% were female, respectively. Around 80% of the OCD patients were considered young and their age ranged from 20–40 years old. Forty percent of caregivers in the current study reported a high burden level. The caregivers of those who had severe OCD symptoms had a lower coping level compared to the caregivers of those with less severe symptoms and those urban caregivers were able to better cope than rural caregivers. There was an association between OCD symptom severity and financial, work-related, social and family relationships, mental and health burdens for family caregivers. Meanwhile, the greater coping level of family caregivers, the lesser social and family, mental, and spouse relationship burden (p < 0.05); (4) Conclusions: The family caregivers of people diagnosed with OCD have specific aspects of burden and coping which require support by designing strategic interventions for family caregiver coping.

Case Report: Pharmacogenetics Applied to Precision Psychiatry Could Explain the Outcome of a Patient With a New CYP2D6 Genotype

Precision medicine applied to psychiatry provides new insight into the promising field of precision psychiatry. Psychotic disorders are heterogeneous, complex, chronic, and severe mental disorders. Not only does the prognosis and the course of the disease vary among patients suffering from psychotic disorders, but the treatment response varies as well. Although antipsychotic drugs are the cornerstone of the treatment of schizophrenia, many patients only partially respond to these drugs. Furthermore, patients often experience adverse events which can lead to poor treatment adherence. Interindividual variability in drug response could be related to age, gender, ethnicity, lifestyle factors, pharmacological interactions, obesity, and genetics, all of which influence the process of drug metabolism. Commonly prescribed antipsychotics are metabolized by cytochrome P450 (CYP450) enzymes, and CYP450 genes are highly polymorphic. Pharmacogenetic testing is increasingly being used to predict a patient's drug response and could help to find the most appropriate therapy for an individual patient. In this report, we describe a psychotic patient who did not receive adequate clinical follow-up and subsequently presented adverse events, which could be explained by his pharmacogenetic profile and the drug interactions resulting from the polypharmacy prescribed.

Mental Health Status before and during the COVID-19 Pandemic in Patients First Visiting a Psychosomatic Internal Medicine Clinic in Tokyo, Japan.

The coronavirus disease (COVID-19) pandemic has aggravated anxiety and depression worldwide, particularly in patients with chronic illnesses and mental disorders. Using validated questionnaires, in this paper, we examine the psychological effects of the pandemic in Japan in detail. The General Mental Health Scale (GHQ), the State–Trait Anxiety Inventory (STAI), and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess mental health, state and trait anxiety, and depression, respectively. The survey was completed during the patients’ first visits to the clinic of Psychosomatic Internal Medicine from November 2018 to April 2021. The Mann–Whitney U test was used to compare data from 226 participants before and during the COVID-19 pandemic. The GHQ total, GHQ subscales of “social dysfunction” and “anxiety and dysphoria”, and state anxiety scores were significantly higher during than before the pandemic. The GHQ total, some GHQ subscales, and state anxiety scores were significantly higher among male than female participants during the pandemic. The GHQ total, some GHQ subscales, CES-D, and state anxiety scores in those aged 10–39 years were significantly higher. Thus, the COVID-19 pandemic may have caused mental health changes in many individuals based on their gender, age, and with time.

An evaluation of the feasibility of implementing a novel tobacco dependence treatment program for high-risk individuals into clinical practice within a community mental health center

BackgroundIndividuals with serious mental illnesses experience deaths related to smoking at a higher prevalence than individuals without a psychotic-spectrum disorders. Traditional smoking cessation programs are often not effective among individuals with chronic mental disorders. Little is known about how to implement a tobacco cessation treatment program for this at-risk population within a community health center. The current study used qualitative methods to examine the factors that may enhance or impede the delivery of a novel tobacco cessation treatment for smokers with a psychotic-spectrum disorder diagnosis in an integrated care community health center.MethodsUsing a case study design, we conducted 22 semi-structured interviews with primary care providers, mental health providers, addiction counselors, case managers, intake specialists, schedulers, pharmacists, and administrative staff employed at the organization. Interviews were transcribed and themes were identified through a rich coding process.ResultsWe identified environmental factors, organizational factors, provider factors and patient factors which describe the potential factors that may enhance or impede the implementation of a smoking cessation program at the integrated care community health center. Most notably, we identified that community mental health centers looking to implement a smoking cessation program for individuals with chronic mental health disorders should ensure the incentives for providers to participate align with the program’s objectives. Additionally, organizations should invest in educating providers to address stigma related to smoking cessation and nicotine use.ConclusionsThe findings of our study provide valuable insight for administrators to consider when implementing a smoking cessation program in an integrated care community health center. Our findings provide public health practitioners with potential considerations that should be discussed when designing and implementing a smoking cessation program for individuals with chronic mental disorders.

Managing Mental Health Problems and Quality of Life among Dialysis Patients through Stress Management Intervention

Objective. Chronic diseases and psychological disorders have privileged co morbidity with each other; dialysis patients are also at high risk of internalizing problems. This study investigated the effectiveness of stress management techniques in controlling internalizing problems and kidney disease related quality of life of the dialysis patientsMethod. This study was completed using repeated measure research design with 20 diagnosed kidney patients found high on mental health problems who were randomly selected from initially approached sample of 100 registered patients in Nishtar Hospital Multan. 20 participants were then randomly assigned to intervention and control group equally. Stress management techniques were administered to intervention group only. Pre and post data were obtained on Kidney Disease Related Quality of Life Scale (Hays et al., 1994) and Depression, Anxiety, Stress Scale (Lovibond &amp; Lovibond, 1995). This study was conducted during 2016-2017.Results. Significant differences were found in pre and post-scores on kidney disease quality of life, depression,anxiety and stress for intervention group (t = 5.03, &lt; .001 and t = 8.12, 1.42,3.02 at &lt;0.01 respectively) while insignificant findings were found for control group. It implies that patients after receiving stress management intervention (Meichenbaum, 1993) reported an increase in quality of life and decrease in their symptoms of depression, anxiety, and stress.Conclusion. Stress management techniques have been found effective in improving kidney related quality of life and lowering depression, anxiety, and stress of kidney patients.Implications. The findings of present study are useful for the physicians and family members of kidney patients. Stress management techniques if are employed by kidney patients' professionals in particular and their family members in general can extend the quality of life and let down the depression, anxiety, and stress. Seminars and workshop should be conducted for the awareness of these internalizing problems and importance of stress management.