AS THE field of medicine widens it presents new challenges to the psychiatric consultation. A recent example has been the interest in the psychiatric aspects of intensive-care-unit patients.1 In recent years, another new category of patient is coming into the purview of psychiatry. This paper will discuss the management of the patient with end-stage renal disease awaiting evaluation for, or institution of, hemodialysis.
These patients are suffering a severe emotional affliction combining the trauma of being near death, the narcissistic injury resulting from the knowledge of organ damage, and extreme dependency upon others. In the face of these difficulties, recurrent psychiatric symptoms are to be expected.2 In addition, during the predialysis phase and occasionally during the postdialysis period the patient is subject to organic cerebral disorders due to uremia, hypertension, and other metabolic defects.3
An essential part of the medical management of this group of patients