Limited research, education slow detection of mental illness among patients with CKD
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While the prevalence of chronic kidney disease is higher in patients with severe mental illness compared with the general population, limited research has made it difficult for staff to detect key markers of mental illness, a speaker said.
“Chronic kidney disease is a multifactorial problem, having both physical and psychological connotations for the patient. Anxiety, delirium, depression and even suicide are common complications observed in patients with renal failure,” Brenda Jahnke, MSN, RN, CNS, house supervisor at the Northern Nevada Medical Center, said at the American Nephrology Nurses Association’s National Symposium, a virtual event.
Individuals with a mental illness often face stigma throughout their lives, Jahnke said. “It’s a negative mark on a person’s image or reputation. The primary burden they have is suffering the illness, and the secondary burden is that they carry the label facing judgment of others.
“We see higher rates of comorbidities, such as cardiovascular, [gastrointestinal] GI and respiratory illnesses. And there are deficits in self-care and engagement in unhealthy lifestyle behaviors.”
Multiple causes
As kidney disease has multiple causes, it is not uncommon for patients to experience different levels of anxiety, depression and other severe forms of mental illness, such as schizophrenia, bipolar disorder and nonorganic psychotic illness, Jahnke said.
“Patients with severe mental illness present an additional challenge to you due to their altered perceptions,” Jahnke said. “Altered thinking, altered responses and a lack of compliance” are common signs, Jahnke said.
Other common signals staff may see in the clinic or hear about from family members include withdrawal from regular activities, loss of emotional warmth and impaired social skills or alterations in energy levels, feeling pleasure and motivation.
Schizophrenia
Schizophrenia, also known as psychosis, “is a serious mental illness that affects how a person thinks, feels and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual and their family members and friends,” Jahnke said. “If left untreated, the symptoms of schizophrenia can be persistent and disabling.”
Patients with schizophrenia have an increased risk of nearly 40% of developing CKD after their diagnosis, Jahnke said.
Patients with bipolar disorder can experience being “low or just being very high, which is the manic component,” Jahnke said. “They may sleep more and [not be] motivated to do anything. They may eat too much or eat too little, and they are preoccupied with death or with their suicide. These are folks who will attempt and often be successful [at suicide].
“Bipolar disorder is recurrent and life-threatening and has the highest rate of suicide among mental disorders,” Jahnke said.
Treatment, training
Some of the medications patients take to treat their mental illness – anti-psychotics – have significant adverse events.
“Acute kidney injury is one and a half times more likely in older adults taking these medications, as are hypotension, urinary retention, pneumonia, heart attack and risk of sudden death. Although there's not a direct cause-and-effect relationship between these drugs and kidney disease, it adds to existing concerns,” Jahnke said.
Jahnke said understanding and detecting mental illness is a missing element in nephrology nurse training, both in nursing school and by dialysis providers.
“I think we do a great job on the clinical side with the body, but you have to remember it is body, mind and spirit,” Jahnke said. “If you are not addressing the patient's psychosocial issues, whether it be depression or severe mental illness, I think you're missing an opportunity to bring the wholeness [of patient care] to what you do.”
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Jahnke B. #221. Presented at: American Nephrology Nurses Association National Symposium; May 1-5, 2021 (virtual meeting).
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