Psychiatric Disorders in Chronic Diseases

As chronic diseases are getting more prevalent, research shows that mental health issues in patients with these diseases have increased. For example, with diabetes patients, there is a 25% increase in the rate of depression. While studying each chronic disease, such as asthma, diabetes, cystic fibrosis, etc., it was seen that the extent of disease management, age and stage of disease all play a role in the development of associated psychiatric disorders. The mental health issues themselves can range from depression and anxiety to emotional and behavioral issues. Eventually, with psychiatric disorders added, the chronic disease patients have poor health outcomes and an increase in other health issues.

For example, in the case of asthma patients, anxiety or conduct issues were higher if the asthma was poorly controlled as opposed to those who had it well-controlled. In cystic fibrosis patients, depression was seen at a higher rate compared to healthy patients. Chronic kidney disease is another chronic condition with long-term lifestyle changes and where the quality of life can get disrupted. In this case, too, there are reports about cognitive abilities being severely affected. Let us dive deeper into what this is.

Chronic Kidney Disease

Before going further, we will first look at the different stages of kidney disease. The main function of the kidney is to filter waste and excess fluid from the blood. When there is any kind of damage to the kidneys, this function slowly starts getting disrupted before eventually not working at all. Depending on the filtration rate, chronic kidney diseases are divided into 5 stages. As the filtration rate goes down, the disease condition worsens.

• In Stage 1 to Stage 3, where the filtration rates are higher, the disease is mainly controlled through lifestyle changes and some medication. The symptoms, like swelling of the feet and hands or changes in urination, progressively start to get worse. At Stage 3, as waste builds up, the patient can experience other health issues.
• By Stage 4, the patient needs to be in constant contact with the nephrologist for proper treatment plans and preparation for the next stages.
• Stage 5 is called end-stage renal disease where the kidneys completely fail to function. Patients will need to go for dialysis treatment or kidney transplant at this point.

What Do We Know about Mental Health in Kidney Disease Patients?

Most research about mental health has been restricted to end-stage renal disease. At this stage, there have been studies showing that up to 60% of patients have some form of cognitive impairment. Depression is also a common problem at this stage of the disease. An increase in uremic toxins (due to improper waste removal) has been identified as one of the main reasons. Apart from this, an increase in reactive oxygen species or inflammatory molecules, changes in blood flow, sleep disorders, and anemia could all play a role in affecting cognitive abilities.

While this is all known to occur at Stage 5 of kidney disease, not much work has gone into studying psychiatric disorders in the early stages of kidney disease.

Psychiatric Disorders in Early Stages of Chronic Kidney Disease

In the above-mentioned research article, the authors looked at close to 1,000 patients who were in the early stages of chronic kidney disease. They belonged to different age groups and were checked for when they had an onset of psychiatric disorder. The authors found that around 1 in 8 patients had a psychiatric disorder after the onset of the kidney disease. Interestingly, adolescents are affected the most. Similar results were seen when looking at individual mental health issues like anxiety and mood disorders. Adolescence is already a critical time for the development of emotional and social habits which affect mental well-being. Added to this, the authors argue that the stress of a chronic disease which affects lifestyle increases the risk of a psychiatric disorder.

This research also supported some earlier work which found that the onset of psychiatric disorder was associated with progression to end-stage renal disease.

Final Takeaway

Patients with kidney-related diseases need to be monitored for mental health-related issues as part of the disease management regimen from the early stages of the disease. This becomes especially important in the adolescent age group.

Note: Some of the authors of the paper declared that they have financial relationships with pharmaceutical companies. It is normal for authors to declare this in case it might be perceived as a conflict of interest. For more detail, see the Conflict of Interest statement at the end of the referenced paper.