Psychonephrology: A Guide to Principles and Practice

Foreword
Preface
Contents
Contributors
Part I: Fundamentals of Psychonephrology
1: Psychiatric Examination in Nephrology
1.1 Introduction
1.2 The Psychiatric Interview
1.2.1 Identifying Data
1.2.2 The Chief Complaint
1.2.3 History of Presenting Illness
1.2.4 Review of Systems and Substance History
1.2.5 The Past Psychiatric History
1.2.6 Past Medical History and Medications
1.2.7 Family History
1.2.8 Personal History
1.3 The Mental Status Examination
1.3.1 Starting with the ABCs: Appearance, Behavior, and Cooperation
1.3.2 Speech
1.3.3 Mood vs. Affect
1.3.4 Thought Process
1.3.5 Thought Content
1.3.6 Perceptual Disturbances
1.3.7 Cognition and Orientation
1.3.8 Insight and Judgment
1.4 The Risk Assessment
1.5 Concluding the Psychiatric Interview
1.6 Special Considerations in the Psychiatric Examination in Nephrology
1.6.1 Depression
1.6.1.1 Case Vignette 1
1.6.1.2 Case Vignette 1 Analysis
1.6.2 Anxiety
1.6.2.1 Case Vignette 2
1.6.2.2 Case Vignette 2 Analysis
1.6.3 Delirium
1.6.3.1 Case Vignette 3
1.6.3.2 Case Vignette 3 Analysis
1.7 Key Takeaways
References
2: Psychometric Assessment of Neuropsychological Function in Kidney Disease
2.1 Introduction
2.2 Psychological Assessment
2.2.1 Common Psychiatric Presenting Concerns
2.2.1.1 Depressive Disorders
2.2.1.2 Case Vignette: “An Unfortunate New Beginning”
2.2.1.3 Suicidality
2.2.1.4 Anxiety Disorders
2.2.1.5 Sleep Disorders
2.2.2 Screening Tools
2.2.2.1 Depressive Disorders
2.2.2.2 Suicidality
2.2.2.3 Anxiety Disorders
2.2.2.4 Sleep Disorders
2.2.3 Case Vignette Analysis: “An Unfortunate New Beginning”
2.2.4 When to Refer for Psychological Assessment
2.3 Neuropsychological Assessment
2.3.1 Case Vignette: “Worsening Cognitive Changes in a Renal Transplant Patient”
2.3.2 Common Cognitive Difficulties
2.3.3 Cognitive Impairment across Disease Course
2.3.4 Case Vignette: “Worsening Cognitive Changes in a Renal Transplant Patient” (Continued)
2.3.5 Impact of Kidney Transplantation on Cognition
2.3.6 Cognitive Screening Tools
2.3.7 When to Refer for Neuropsychological Assessment
2.3.8 Case Vignette Analysis: “Worsening Cognitive Changes in a Renal Transplant Patient”
2.4 Key Takeaways
References
3: Current State, Knowledge Gaps, and Management Strategies of Kidney Disease for the Psychiatrist
3.1 Case Vignette
3.2 Chronic Kidney Disease (CKD)
3.2.1 Defining CKD
3.2.2 Epidemiology of CKD
3.2.3 Evaluation of CKD
3.2.4 Complications and Management of CKD
3.2.5 Predicting Progression of CKD to ESKD
3.3 Renal Replacement Therapies
3.3.1 Hemodialysis
3.3.2 Peritoneal Dialysis
3.3.3 Transplantation
3.3.4 Conservative Kidney Care
3.4 Case Vignette Analysis
3.5 Key Takeaways
References
4: Renal Transplant Essentials
4.1 Renal Transplant Statistics
4.2 Case Vignette
4.3 Pretransplant Considerations
4.3.1 Transplant Recipient Assessment
4.3.2 Transplant Donors
4.3.3 Transplant Listing
4.4 Immunosuppression
4.4.1 Common Immunosuppressive Agents
4.4.2 Adherence to Immunosuppression
4.4.3 Psychiatric and Psychological Reactions to Immunosuppression
4.5 Posttransplant Complications
4.5.1 Surgical Complications
4.5.2 Infections
4.5.3 Delayed Graft Function and Graft Loss
4.5.4 Posttransplant Delirium
4.5.5 Posttransplant Cognitive Impairment
4.6 Case Vignette Analysis
4.7 Key Takeaways
References
5: Overview of Psychopharmacology Principles in Nephrology
5.1 Introduction
5.2 Case Vignette
5.3 Pharmacokinetics and the Kidney
5.3.1 Absorption
5.3.2 Distribution
5.3.3 Metabolism
5.3.4 Elimination
5.3.5 Acute Kidney Injury
5.3.6 Hemodialysis
5.3.7 Renal Transplantation
5.4 Recommendations for Dosage Adjustment of Psychotropic Drugs in Patients with Renal Impairment
5.4.1 Antipsychotics
5.4.2 Antidepressants
5.4.3 Mood Stabilizers
5.4.4 Benzodiazepines/Non-benzodiazepines
5.4.5 Cognitive Enhancers
5.5 Case Vignette Analysis
5.6 Key Takeaways
References
6: Renal Toxicity of Psychotropic Medications
6.1 Introduction
6.2 Case Vignette
6.3 Lithium and Chronic Renal Impairment
6.3.1 Acute Lithium Toxicity
6.3.2 Diabetes Insipidus
6.3.3 Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT)
6.4 Antidepressants
6.4.1 Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)
6.5 Antipsychotics
6.6 Other Psychotropic Drugs
6.7 Case Vignette Analysis
6.8 Key Takeaways
References
7: Overview of Psychotherapy Principles for Patients with Kidney Disease
7.1 Introduction
7.1.1 What Is Psychotherapy?
7.2 Relevance of Psychotherapy for Renal Patients
7.2.1 Common Presenting Concerns
7.2.2 Case Vignette: “One Thing After Another”
7.3 Biopsychosocial Model
7.3.1 Multidisciplinary Care
7.3.2 Patient Confidentiality in Multidisciplinary Care
7.3.3 Case Vignette: “One Thing After Another” (Continued)
7.4 Cognitive Behavioral Therapy
7.4.1 Efficacy of CBT with Kidney Patients
7.4.2 CBT Techniques
7.4.3 Considerations in Evaluating CBT Suitability
7.5 Applying CBT with Renal Patients
7.5.1 Self-Learning
7.5.2 Goal Setting
7.5.3 Case Conceptualization
7.5.4 Deciding on a Treatment Setting
7.5.5 Structure of CBT
7.5.6 Psychotherapist Flexibility
7.5.7 Symptom Monitoring
7.5.8 Motivational Enhancement
7.6 Challenges in Providing Psychotherapy to Kidney Patients
7.6.1 Strategies for Addressing Cognitive Impairments in Psychotherapy
7.7 Case Vignette Analysis: “One Thing After Another”
7.8 Key Takeaways
References
8: Decisional Capacity Determinations in Psychonephrology
8.1 Introduction
8.2 Decisional Capacity: Medical Informed Consent
8.3 Decisional Capacity: Appointment of Surrogate
8.4 Dispositional Capacity
8.5 Neuropsychiatric Illnesses Leading to Impaired Decisional Capacity
8.5.1 Neurocognitive Disorders
8.5.2 Psychotic and Depressive Disorders
8.5.3 Specific Decisional Capacity Scenarios in Psychonephrology
8.6 Clinical Approaches to Decisional Capacity Determinations
8.7 Bioethical Approaches to Decisional Capacity Determinations in Psychonephrology
8.8 Case Vignettes and Analyses
8.8.1 Case Vignette 1: Request for Discharge Against Medical Advice
8.8.2 Case Vignette 2: Request for Changing Treatment to Renal Transplant
8.8.3 Case Vignette 3: Request for Hemodialysis Discontinuation
8.8.4 Case Vignette 4: Request for Other Organ Transplant
8.9 Key Takeaways
References
9: Consultation-Liaison Psychiatry and Collaborative Care Models of the Patient with Renal Disease
9.1 Introduction
9.1.1 Case Vignette 1
9.2 The Chronic Care Model
9.2.1 Case Vignette 1 (Continued)
9.3 Collaborative Care and Consultation-Liaison Psychiatry
9.3.1 Case Vignette 2
9.3.2 Collaborative Care
9.3.3 Case Vignette 3
9.3.4 Consultation-Liaison Psychiatry
9.4 Collaborative Mental Health Care for CKD Patients
9.5 Case Vignette Analyses
9.5.1 Case Vignette 1
9.5.2 Case Vignette 2
9.5.3 Case Vignette 3
9.6 Key Takeaways
References
Part II: Common Psychiatric Presentations and Their Management in the Patient with Kidney Disease
10: Common Psychiatric Disorders in the Renal Patient
10.1 Introduction
10.2 Depressive Disorders
10.2.1 Case Vignette 1: The Depressed Patient
10.2.2 Case Vignette 1 Analysis
10.2.3 Epidemiology and Risk Factors
10.2.4 Diagnosis of Depressive Disorder in Renal Impairment
10.2.5 Outcomes and Prognostic Considerations
10.2.6 Treatment of ESRD as It Relates to Depressive Disorder
10.3 Anxiety Disorders
10.4 Trauma and Stressor-Related Disorders
10.4.1 Case Vignette 2: The Adjustment Disordered Patient
10.4.2 Case Vignette 2 Analysis
10.5 Bipolar Disorders
10.6 Psychotic Disorders
10.6.1 Case Vignette 3: The Psychotic Patient
10.6.2 Case Vignette 3 Analysis
10.7 Severe Mental Illness
10.8 Insomnia and Other Commonly Encountered Sleep Problems
10.9 Key Takeaways
References
11: Substance Use Disorders and the Kidney
11.1 Introduction
11.2 Case Vignette: “A Rapid Crush”
11.3 Substance Use and the Kidney
11.3.1 Alcohols
11.3.2 Anabolic Androgenic Steroids
11.3.3 Cannabis
11.3.4 Dissociatives
11.3.5 Hallucinogens
11.3.6 Inhalants
11.3.7 Novel Psychoactive Substances
11.3.8 Opioids
11.3.9 Sedative-Hypnotics
11.3.10 Psychostimulants
11.3.11 Tobacco
11.4 Persons Who Inject Drugs
11.5 Substance Use Disorders and Renal Transplant
11.6 Substance-Induced Versus Other Comorbid Psychiatric Illness
11.7 Recovery Programs and Interventions
11.8 Case Vignette Analysis: “A Rapid Crush”
11.9 Key Takeaways
References
12: Neurocognitive Ramifications of Renal Disease
12.1 Introduction and Epidemiology
12.2 Anatomic and Cognitive Correlates of CKD
12.2.1 Magnetic Resonance Imaging (MRI) Findings
12.2.2 Patterns of Cognitive Impairment in CKD
12.3 Pathophysiology of Cognitive Impairment in CKD
12.3.1 Delirium
12.3.1.1 Medication Toxicity Causing Delirium
12.3.2 Cerebrovascular Disease and Stroke
12.3.3 Other Pathophysiologic Mechanisms
12.3.3.1 Uremia
12.3.3.2 Endothelial Dysfunction
12.3.3.3 Neuroinflammation
12.3.3.4 Miscellaneous Factors
Hyperhomocysteinemia
Alterations in the Gut Microbiome
The Effect of Anemia in CKD
Sleep Disturbances
12.4 Transition to Renal Replacement Therapy and Effects on Cognitive Function
12.4.1 Delirium Induced by Hemodialysis
12.5 Cognitive Assessment in CKD
12.6 Case Vignette
12.7 Case Vignette Analysis
12.8 Key Takeaways
References
13: Sexuality and Sexual Dysfunction in the Renal Patient
13.1 Introduction
13.2 Case Vignette
13.3 Sexuality and Kidney Disease
13.3.1 Gender and Sexual Orientation
13.4 Sexual Dysfunction in Women with Chronic Kidney Disease
13.5 Sexual Dysfunction in Men
13.6 Case Vignette Analysis
13.7 Key Takeaways
References
14: Psychotoxicity of Immunomodulators: Corticosteroids, Mycophenolate, Tacrolimus, Cyclophosphamide, and Hydroxychloroquine
14.1 Corticosteroids
14.1.1 Overview
14.1.2 Range of Psychiatric Side Effects of Corticosteroids
14.1.3 Timing of Symptom Onset
14.1.4 Dose Dependence
14.1.5 Risk Factors
14.1.6 Pathophysiology
14.1.7 Treatment of Corticosteroid-Induced Psychiatric Reactions
14.1.8 Case Vignette: Corticosteroid-Induced Psychiatric Symptoms
14.2 Mycophenolate
14.3 Tacrolimus
14.3.1 Overview
14.3.2 Tacrolimus-Induced Catatonia
14.3.3 Tacrolimus-Induced Psychosis
14.3.4 Psychotoxic Effects of Tacrolimus in Pediatrics
14.3.5 Pathophysiology
14.3.6 Case Vignette 1: Tacrolimus-Induced Psychosis
14.3.7 Case Vignette 2: Tacrolimus-Induced Catatonia
14.4 Cyclophosphamide
14.5 Hydroxychloroquine
14.5.1 Overview
14.5.2 Case Vignette: Hydroxychloroquine-Induced Psychiatric Symptoms
14.6 Key Takeaways
References
15: Psychological Aspects of Adaptation to Critical Care Nephrology, Dialysis, and Transplantation for the Patient and the Caregiver
15.1 Introduction
15.2 Case Vignette – “Brenda in Renal Crisis: Critical Care Nightmare”
15.3 Psychological Adjustment and Adaptation in Chronic Illness
15.4 Case Vignette – “Brenda and John in Recovery: Adjustment Post-critical Illness”
15.5 Qualitative Studies of Adjustment in Patients with End-Stage Renal Disease
15.6 Case Vignette – “Brenda and John in Dialysis: Back to the Grind”
15.7 Post-transplant Adjustment
15.8 Caregiver Roles and Adjustments
15.9 Case Vignette – “Brenda and John in Transplant: Walking into the Sunset – Not!”
15.10 Key Takeaways
References
16: Palliative, End-of-Life, and Psychiatric Care of Patients with Advanced Renal Disease
16.1 Introduction
16.2 Case Vignette
16.3 Palliative Care Principles
16.4 Serious Illness Conversations Establish Patient Values and Goals
16.5 How to Approach Patients with CKD Stages 4 and 5 and Who Are Contemplating Initiating or Discontinuing Dialysis
16.6 Identifying Psychiatric Disorders in the Palliative Care Setting
16.6.1 Major Depression
16.6.2 Anxiety
16.6.3 Delirium
16.7 End-of-Life Symptom Management
16.7.1 Pain
16.7.2 Dyspnea
16.7.3 Delirium
16.7.4 Constipation
16.7.5 Secretions
16.8 Case Vignette Analysis
16.9 Key Takeaways
References
17: Difficult Patient Encounters in Nephrology
17.1 Introduction
17.1.1 Case Vignette 1
17.2 Etiology
17.2.1 Patient Factors
17.2.1.1 Special Characteristics of Nephrology Patients
17.2.1.2 Personality Trait Domains
17.2.1.3 Case Vignette 2
17.2.1.4 Categorical Personality Disorders
17.2.2 Physician Factors
17.2.3 Case Vignette 3
17.3 Interventions
17.3.1 Strategies
17.4 Case Vignette Analyses
17.4.1 Case Vignette 1 Analysis
17.4.2 Case Vignette 2 Analysis
17.4.3 Case Vignette 3 Analysis
17.5 Key Takeaways
References
Part III: Special Issues in Psychonephrology
18: Chronic Kidney Disease and the Aging Population: Addressing Unmet Needs
18.1 Geriatric Syndromes in Patients with Chronic Kidney Disease
18.1.1 Frailty
18.1.2 Case Vignette 1
18.1.2.1 Case Vignette 1 Analysis
18.1.3 Case Vignette 2
18.1.3.1 Case Vignette 2 Analysis
18.1.4 Falls
18.1.5 Cognitive Impairment
18.2 Treatment Decisions in the Older Adult Patient
18.2.1 Life Expectancy of Older Adult Patients with ESKD
18.2.2 Hemodialysis vs. Peritoneal Dialysis
18.2.3 Vascular Access Considerations for Hemodialysis
18.2.4 Renal Transplant in Older Patients
18.2.5 Comprehensive Conservative Care
18.2.6 Case Vignette 3
18.2.6.1 Case Vignette 3 Analysis
18.3 Key Takeaways
References
19: Physical Activity and Nutrition in Chronic Kidney Disease
19.1 Introduction
19.2 Case Vignette: “Samuel and Soccer”
19.3 Health, Wellness, and Quality of Life
19.4 Physical Activity, Exercise, and Fitness
19.4.1 Defining Key Terms
19.4.2 Physical Health Benefits of Exercise
19.4.3 Mental Health Benefits of Exercise
19.4.4 Physical Activity in Chronic Kidney Disease
19.4.5 Mitigating Health Risk in Exercise
19.4.6 Prescribing Physical Activity
19.5 Case Vignette: “Ana and Getting Going”
19.6 Nutrition and Dietary Management
19.6.1 Nutrition Science Basics
19.6.2 Nutrition for Physical and Mental Health
19.6.3 Nutrition and Cardiovascular Disease Risk
19.6.3.1 Diabetes Mellitus
19.6.3.2 Hypertension
19.6.3.3 Obesity
19.6.3.4 Lipids
19.6.4 Nutrition and Chronic Kidney Disease
19.6.4.1 Protein
19.6.4.2 Potassium
19.6.4.3 Phosphorus
19.6.4.4 Sodium
19.6.4.5 Fluid
19.6.4.6 Iron
19.6.4.7 Vitamin D
19.6.4.8 Calcium
19.6.4.9 Calories
19.7 Lifestyle Modification
19.7.1 Stages of Change
19.7.2 Patient- and Person-Centered Care
19.7.3 Motivational Interviewing
19.7.4 Interprofessional Teamwork
19.7.5 Chronic Disease Self-Management (CDSM)
19.8 Physician Advocacy
19.9 Vignette Analyses: “Samuel and Ana: Learning and Living”
19.10 Key Takeaways
References
20: Gender Disparity and Women’s Health in Kidney Disease
20.1 Introduction
20.2 Gender Disparities in Chronic Kidney Disease
20.3 Gender Disparities in Hospitalizations and Mortality in Patients with ESKD
20.4 Gender Differences in Kidney Transplantation
20.5 Common Disorders and Psychosocial Concerns of Women with Kidney Disease
20.5.1 Depressive Disorders
20.5.2 Sexual Dysfunction
20.6 Pregnancy in CKD
20.7 Pregnancy in Kidney Transplant
20.8 Case Vignette
20.9 Case Vignette Analysis
20.10 Postpartum Care in Patients with CKD
20.11 Key Takeaways
References
21: Cultural Considerations When Caring for Racial and Ethnic Minority Patients with End-Stage Renal Disease
21.1 The Basics of Chronic Kidney Disease and End-Stage Renal Disease
21.2 The Global Burden of CKD and ESRD
21.2.1 ESRD Prevalence Among Racial/Ethnic Minority Groups
21.2.2 Race and Ethnicity as Social Constructs
21.3 Renal Health Disparities Among Racial/Ethnic Minority Groups
21.3.1 The Social Determinants of Renal Health Among Racial/Ethnic Minority Groups
21.4 Case Vignette: “Lost in Translation”
21.5 Culture as a Determinant of Renal Health Among Racial/Ethnic Minority Groups
21.5.1 Ethnocentrism as a Barrier to Understanding the Impact of Culture on Renal Health
21.6 Establishing Cultural and Linguistic Competency in Renal Care
21.6.1 Clinician, Know Thyself: Individual-Level Strategies
21.6.2 Case Vignette Analysis: “Lost in Translation”
21.6.3 Through the Looking Glass: Organizational-Level Strategies
21.6.4 Challenging Eurocentrism in Medicine: Systemic-Level Strategies
21.7 Key Takeaways
References
22: Occupation-Related Stress Affecting Physicians Caring for Patients with Renal Disease
22.1 The Basics of Burnout
22.1.1 Defining Burnout
22.1.2 Measuring Burnout
22.2 Burnout in the Medical Profession
22.2.1 A Leg Up on a Difficult Climb
22.3 Case Vignette: “A Slow Burn”
22.4 Burnout in the Nephrology Workforce
22.4.1 A Concerning Trend in Nephrology
22.5 Contributing Factors to Burnout in Nephrology
22.5.1 Individual Risk Factors
22.5.2 Organizational Risk Factors
22.5.3 The Impact of Moral Distress
22.5.4 Systemic Risk Factors
22.6 Case Vignette Analysis: “A Slow Burn”
22.7 The Consequences of Burnout in Nephrology
22.7.1 Individual Effects
22.7.2 Patient Care Effects
22.7.3 Health Systems Effects
22.8 Facilitating Physician Wellness in Nephrology
22.8.1 Redefining Physician Wellness
22.8.2 Boosting Physician Resilience
22.8.3 Driving Efficiency of Practice
22.8.4 Alleviating Moral Distress
22.8.5 Fostering a Culture of Wellness
22.9 Key Takeaways
References
23: Modernizing Continuing Professional Development Using Social Media
23.1 Introduction
23.1.1 What Is SoMe?
23.1.2 Networked Learning
23.2 Case Vignette
23.3 Problems and Barriers to Using Social Media for Continuing Professional Development
23.3.1 Digital Identity Formation and Personal Bandwidth
23.3.2 Professionalism
23.3.3 Privacy
23.4 A “How To” Guide for Harnessing the Power of SoMe for Continuing Professional Development
23.4.1 Getting Started on Twitter
23.5 Building and Sustaining Cross-Disciplinary Virtual Communities of Practice
23.5.1 Bringing Disciplines Together
23.5.2 Creating an Online Rally Point
23.5.3 Sustainability and Structures
23.6 The Future
23.7 Case Vignette Analysis
23.8 Key Takeaways
References
24: Psychonephrology of the Future: A Global Psychiatry and Nephrology Inter-specialty Curriculum for Training the Next Generation of Specialists
24.1 Introduction
24.2 Future Developments in Psychonephrology
24.2.1 Educational Milestones
24.2.2 Educational Models
24.3 Future Directions and Fostering Collaboration
24.4 Key Takeaways
References
Index