Failure to Understand Dialytic Therapy

Abstract

A 27 year old schizophrenic woman who is permanently hospitalized at a state psychiatric institute developed end-stage kidney disease due to lupus nephritis. It has been over six years since the patient conversed with anyone in a rational manner. Initial hemodialyses were accomplished by sedating the patient who awoke repeatedly, shouting and clashing with her attendants. Both arterial and venous lines were pulled out by the patient during each dialysis, leading to extensive hemorrhage on one occasion. A psychiatric consultant indicates that there is no likelihood of improvement in the patient’s psychosis which has not responded to electric shock, large doses of phenothiazines, and other drug regimens. The responsible nephrologist states her intent to not perform any further dialytic therapy.