Tetsuo Shirai

PSYCHIATRIC DISORDERS AMONG PATIENTS UNDERGOING HEMODIALYSIS THERAPY

We examined the incidence rates of psychiatric disorders in end-stage renal failure patients on hemodialysis (HD) based on 4-year long-term follow-up. Among various psychiatric disorders, the frequency of three psychiatric disorders, dementia, delirium, and major depression, was relatively high. One-year incidence rate of whole psychiatric disorders was 10.6% (7.1% in non-aged and 13.7% in aged). One-year incidence rate of dementia in aged patients was 4.2% (dementia of the Alzheimer’s disease, 0.5%; multi-infarct dementia, 3.7%). One-year incidence rate of multi-infarct dementia in aged HD patients was 7.4 times as large as that in the elderly general populations, suggesting that aged HD patients tend to exhibit multi-infarct dementia. The high incidence rate may be closely related to advanced arteriosclerosis and other medical conditions. Psychiatric management is required for ESRD patients with three major psychiatric disorders, dementia, delirium, and major depression, in particular for aged patients with multi-infarct dementia who has received long-term HD therapy.

Facial Paresthesias Resembling Restless Legs Syndrome in a Patient on Hemodialysis

Accessible online at: http://BioMedNet.com/karger Dear Sir, Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant limb sensations that are precipitated by rest and relieved by activity [1, 2]. RLS symptoms worsen during the evening and may result in insomnia [1, 2]. Most cases are idiopathic, although the condition is sometimes familial and may be associated with a range of medical illnesses, including end-stage renal disease (ESRD) and iron deficiency anemia. RLS is responsive to several medications, including levodopa, dopamine agonists, and benzodiazepines. Despite recent attempts to better characterize RLS, this neurologic disorder remains poorly understood. We have recently encountered a male hemodialysis (HD) patient who exhibited unpleasant facial paresthesias that closely resemble the unpleasant lower extremity sensations seen in RLS. The patient was a 52-year-old man. He had been receiving HD due to ESRD since 48 years of age. He had no history of a neurological and/or psychiatric disorder. No abnormal findings except for the paresthesias were found on neurological examination. His only psychiatric symptoms were irritability secondary to the unpleasant facial sensations that were precipitated by rest and relieved by activity. He described the sensations as ‘water-like fluid flowing into several tubes under my facial skin which sometimes itches’. He stated that he had the symptoms for about 1 year, they were worsened by rest, such as during HD therapy, and also worsened in the evening. Although neither minor tranquilizers, including benzodiazepines, nor major tranquilizers were effective for the unpleasant sensations, levodopa was effective. While the paresthesias in this patient were manifested in the face, the characteristics of these symptoms were strikingly similar to those seen in RLS. We report herein the first case to our knowledge of unpleasant facial sensations which closely resemble the clinical characteristics of RLS in a HD patient. One may speculate that, although the etiology of the unpleasant facial sensations in this patient is unclear, this symptom may be a subtype of the RLS frequently seen in HD patients.

A Hemodialysis Patient with Trazodone-Induced Parkinsonism

A hemodialysis male patient exhibited depressive symptoms and trazodone was prescribed orally. Although his depressive symptoms disappeared, he gradually presented with parkinsonism. His parkinsonism improved within a week after stopping trazodone. The clinical course strongly suggested that it was induced by trazodone. However, there is no report on antidopaminergic side effects of parkinsonism. This case suggests that antidopaminergic effects leading to parkinsonism need to be considered in patients on hemodialysis that are taking trazodone.

Cardiac Arrest Caused by Maprotiline in an Elderly Hemodialysis Patient

It is commonly known that patients with a depressive disorder often have some medical comorbidity due to antidepressant medication, although tricyclic antidepressants are associated with cardiovascular disease [1]. They are often given to cardiac patients [1–3]. In particular, amitriptyline has been reported to account for approximately 39% of the deaths due to a tricyclic overdose [2]. Several studies have demonstrated that maprotiline, a tetracyclic antidepressant with noradrenaline reuptake inhibition, produces fewer cardiovascular effects than tricyclics [4]. Recent studies, however, have shown that the cardiac effects of maprotiline do not differ either in quality or quantity from those of the tricyclic substances. We report here on an elderly depressed patient on hemodialysis who had a cardiac arrest which may have been caused by maprotiline [1, 2].

Musical Hallucinations after Childbirth in a Female Patient on Hemodialysis

This article is also accessible online at: http://BioMedNet.com/karger Dear Sir, It is very difficult for patients with endstage renal disease (ESRD) receiving hemodialysis (HD) therapy to undergo childbirth without several somatic risks. ESRD patients may attempt to give birth after receiving kidney transplants. In the United States, the number of ESRD patients who receive a kidney transplant is approximately 1,000/ year; in Japan the number is 600/year. In Japan, therefore, even if patients have a strong desire for pregnancy, they do not usually have a chance for this. ESRD patients on HD therapy have a number of stressful circumstances (e.g., time restrictions due to the HD therapy and control of body weight) [1, 2]. Many patients are prone to unstable mood states [1, 2]. There have been few reports regarding psychiatric symptoms after childbirth in HD patients. We have recently seen a female HD patient who exhibited various psychiatric symptoms including musical hallucinations, panic attacks, and psychogenic pain 18 months after delivery. The patient was a 37-year-old woman receiving HD therapy for 3 years. She had a strong desire for a child. There were several reasons for this. She had already reached middle age. Her relationship with her mother was poor due to her parent’s divorce. She had hoped for a warm home with her own children. Her pregnancy and delivery were successful. For the 1st year, she did her best to take care of her baby, although she was busy going for HD therapy two or three times a week, household matters, etc. She gradually developed fatigue and then suddenly exhibited musical hallucinations, panic attacks, and psychogenic pain. She strongly complained of the musical hallucinations. Although several studies have examined musical hallucinations [3, 4], much still remains unknown. A recent study [4] reported 2 cases of tricyclic-induced musical hallucinations. In our case, however, tricyclic antidepressants were an effective treatment. One may speculate that the musical hallucinations observed in this case may have been caused by psychogenic factors after delivery. We report herein the first case, to our knowledge, of musical hallucinations after childbirth in a HD patient. OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO