| [ Summary ] |
In this review, problems surrounding diagnosis and treatment of major depressive disorder, bipolar disorder and senile depression in patients being maintained on dialysis are discussed. Although depressive disorders are the most common psychopathological condition in dialysis patients, they are still under-recognized and misdiagnosed. Diagnosis of mental disorders can be undertaken using a diagnostic criterion. However when applied to dialysis populations, screening tools such as the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), are sensitive to criterion contamination, in that they include somatic elements, which overlap with the symptoms of physical illnesses. Dialysis patients score highly in relation to these criteria. Two severe symptoms, depressed mood and loss of interest, are strongly associated with major depressive disorder (DSM-IV) in patients with chronic illness. Differential diagnosis of bipolar disorder, differentiating it from other related disorders, including major depressive disorder, is critical in selecting appropriate pharmacological treatment. Correct diagnosis is associated with better prognosis. Paying attention to slight changes in what patients are saying and doing is helpful in the early detection of depressive states. |