Liaison Psychiatry Considerations in Renal Hemodialysis Patients with Acute Organic Cerebral Disorders

Abstract

Renal personnel are trained and equipped to deal with medical emergencies but have little training in the management of acute behavioral, cognitive, and emotional changes. The disoriented, combative, noncompliant, or paranoid patient presents a host of problems. The main focus of this discussion is the recognition that acute alterations of personality and mentation often herald an organic cerebral disturbance. Patients with chronic renal disorders are particularly susceptible to a variety of severe physiological disturbances and subsequent cerebral disorders (Table 1). Typically, emergency psychiatric consultation is requested following an abrupt change in the patient’s behavior. At the University of Chicago hospitals, as high as 50% of all emergency psychiatric consults were ultimately found to be related to patients with organic cerebral disorders. This indicates that there is both a difficulty in recognizing organic causes of confusion and delirium and an inexperience in managing such disturbances. This combination of factors places the renal liaison psychiatrist in an important role due to his training in evaluating mental status, his ability to understand the interpersonal concerns between staff and patient, and his understanding of abnormal behavior.