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PSYCHIATRIC MORBIDITY AND QUALITY OF LIFE IN PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) ATTENDING UNIVERSITY OF ILORIN TEACHING HOSPITAL

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Supervisor: DR P .O AJIBOYE
Faculty: PSYCHIATRY
Month: 11
Year: 2011

Abstract

Chronic Kidney Disease (CKD) is a serious medical condition, which is progressive and potentially life threatening. It is associated with high physical and psychiatric co morbidities. The presence of these co morbidities and other social and clinical issues may invariably affect the quality of life of the affected person. The objectives of the study were to determine the prevalence and pattern of psychiatric morbidity, and the quality of life of CKD patients attending University of Ilorin Teaching Hospital. The relationship between sociodemographic, risk factors for CKD, clinical factors and psychiatric morbidity with the quality of life of the patients were assessed. The study population consisted of 113 adult CKD patients attending renal clinic of University of Ilorin Teaching Hospital, Ilorin. The information about their sociodemographic characteristics, risk factors for CKD, and clinical characteristics were obtained on a prepared proforma questionnaire. Relevant data on medications, previous and current renal replacement therapy (RRT), laboratory records, and medical complications were extracted from the patients’ case notes. Psychiatric diagnostic interview were done on all the patients using Schedules for Clinical Assessment in Neuropsychiatry (SCAN) by the researcher. Psychiatric diagnosis was made in accordance with DSM-IV criteria and quality of life was assessed using the 26-item WHOQOL-BREF. The prevalence of psychiatric disorder in the study population was 31%. Mood disorder accounted for 23.9% (major depressive disorder: 22.1%; Dysthymia: 1.8%), anxiety disorder 5.3% (generalized anxiety disorder: 4.4%; post traumatic stress disorder: 0.9%) and schizophrenia, 1.8%. Significant association was found between the development of psychiatric disorders in CKD patients and younger age group, Christianity, higher level of education, use of unprescribed medication, advance/late level of CKD, presence of complications, higher number of medication use and being on a current renal replacement therapy (RRT) treatment. On the overall quality of life: 79.6% of the respondent scored “fair” (i.e., by using mean ± 1Standard Deviations (SD) to select them), 14.2% scored “poor” (i.e., respondents with scores < mean-1SD) while 6.2% had a good score (i.e., respondents with scores > mean+1SD). On health satisfaction: 64.6% of the respondents scored “fair”, 29.2% scored “good” while 6.2% had a poor score. On the physical health domain: 55.8% of the respondents had a “fair” score, 23% had a “poor” score while 21.2% had a “good” score. On the psychological health domain: 66.4% of the respondents had a “fair” score, 25.7% had a “poor” score and 8% had a “good” score. On the social relationship domain: 58.4% of the respondents scored “fair”, 24.8% scored “good”, while 16.8% had a “poor” score. On the environment domain: 69.9% of the respondents had a “fair” score, 17.7% had a “poor” score while 12.4% had a “good” score. Most of the CKD patients with poor quality of life had a psychiatric diagnosis. Younger age group, higher level of education and receiving adequate social support were associated significantly with good quality of life. Also, the use of unprescribed medication, advanced stage of CKD, presence of complication, using higher number of medications and being on a current treatment with RRT were associated significantly with a poor quality of life. The study showed that high proportion of CKD patients had a psychiatric disorder which subsequently has a significant effect on their quality of life. The study has provided baseline information for further research on psychiatric disorder and quality of life in CKD patients in Ilorin, Nigeria. It also highlights a need for increase collaboration with mental health professionals in the management of CKD patients. Doing so would help improve their quality of life.

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