Psychiatry and treatment adherence in the renal unit

MRC Clinical Research Training Fellow, Mental Health Group, University of Southampton, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG, UK

Phipps & Turkington (2001) gave a good overview of the range of psychological difficulties experienced by patients in a renal unit. However, there was one important omission; non-adherence to treatment. Non-adherence to dietary and fluid restrictions by patients receiving dialysis is well recognised and non-adherence to immunosupressant medication following transplantation is now being seen as a major problem. There are several studies showing that at least 20% of all transplant recipients omit some of their immunosuppressants and that non-adherence is a leading cause of premature transplant failure (Schweizer et al, 1990). Adherence research in patients with renal and other chronic conditions has indicated the importance of health beliefs (Horne, 1998) and mental state (Bunzel & Laederach-Hofmann, 2000) in determining adherence, yet renal staff are likely to have received little, if any, training in the assessment of such areas. Non-adherence to treatment is thus a field in which psychological intervention is likely to make a positive impact and is therefore an area that requires further attention by liaison psychiatrists.

References

Bunzel, B. & Laederach-Hofmann, K. (2000) Solid organ transplantation: are there predictors for posttransplant non-complicance? A literature overview. Transplantation, 70, 711–716.[Medline]

Horne, R. (1998) Adherence to medication: a review of existing research. In Adherence to Treatment in Medical Conditions (eds L. B. Myers & K. Midence), pp. 285–310. Australia, UK: Harwood Academic Publishers.

Phipps, A. & Turkington, D. (2001) Psychiatry in the renal unit. Advances in Psychiatric Treatment, 7, 426–432.[Free Full Text]

Schweizer, R. T., Rovelli, M., Palmeri, D., et al (1990) Noncomplicance in organ transplant recipients. Transplantation, 49, 374–377.[Medline]

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