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2006, vol. 63, br. 4, str. 397-402
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Tanatofobija kod bolesnika na dijalizi
Tanatophobia in the patients on dialysis
aUniverzitet u Istočnom Sarajevu, Medicinski fakultet, Foča, Republika Srpska, BiH bKlinički centar Srbije, Klinika za psihijatriju, Beograd cUniverzitet u Beogradu, Medicinski fakultet, Institut za medicinsku statistiku i informatiku
e-adresa: milanov@spinter.net
Sažetak
Uvod/Cilj. Tanatofobija, strah od smrti, kao specifični strukturisani strah večna je tema u psihijatriji i bliskim disciplinama i naukama. Javlja se u detinjstvu, pojačava se starenjem, kada može biti udružena i sa nozofobijom i drugim mentalnim poremećajima. Cilj ove studije bio je analiza tanatofobije kod bolesnika na dijalizi, koja je bila u direktnoj vezi sa osnovnim poremećajem, kao i uticaj ovog poremećaja na funkcionisanje i kvalitet življenja pacijenata na dijalizi. Metode. Ispitano je 753 bolesnika sa dijagnozom bubrežne insuficijencije koji su se nalazili na hroničnom programu hemodijalize u periodu od 1999. do 2004. godine. Bolesnici su bili podeljeni u dve grupe: grupu od 348 bolesnika sa balkanskom endemskom nefropatijom (BEN) i kontrolnu grupu od 405 bolesnika sa terminalnom i ostalim dijagnozama bubrežne isuficijencije (N18). Ispitivanje je bilo po tipu komparativne studije preseka, a bolesnici su bili testirani upitnicima za procenu anksioznosti, depresivnosti i opšteg mentalnog funkcionisanja. Statistička analiza je vršena standardnim deskriptivnim i analitičkim statističkim metodama. Rezultati. Na osnovu sociodemografskih podataka nađene su sledeće statistički visoko značajne razlike: po mestu življenja između grupe BEN i N18 (χ2 = 23,970; p < 0,01), u učestalosti javljanja bubrežnog komorbiditeta (χ2 = 23,970; p < 0,01), u učestalosti porodičnog bubrežnog komorbiditeta (χ2 = 23,970; p < 0,01), u učestalosti migracija (χ2 = 4,874; p < 0,01). Primenom psihijatrijskih skala, nađeno je da su bolisnici BEN grupe značajno anksiozniji i depresivniji. Zaključak. Tanatofobiju su imale obe ispitivane grupe, ali značajno češće se javljala kod BEN nego kod drugih nefroloških oboljenja. Tanatofobija počinje pre dijalize, a dijalizom se strukturiše u strah od umiranja koji je direktno vezan za osnovnu bolest. Ovaj intenzivni strah može biti povezan i sa demencijom i depresijom, ali i drugim mentalnim oboljenjima.
Abstract
Background/Aim. Thanatophobia is an exaggerated, specific, structured fear of death. It appears in childhood and continues to grow over the years, and in the old age it is accompanied with nosophobia and other mental disorders. The aim of this study was to analyze thanatophobia in dialysed patients which was in the direct connection with a basic disorder, and the influence of this disorder on functioning and the quality of life of the patients on dialysis. Methods. In the study we examined 753 patients from the chronic program of haemodialysis in a period from 1999 to 2004. The patients were classified in two groups: 348 randomized patients with Balkan Endemic Nephropathy (BEN), and the control group (N18) of patients with terminal renal insufficiency, and other diagnoses (n = 405). Since the study was a comparative, cross-sectional one, the patients were tested by the appropriate questionnaires for anxiety, depression and general mental functioning. Statistical analysis was done by the standard descriptive and analytic statistic methods. Results. Based on socio-demographics data we revealed a highly significant difference regarding the place of living between the groups BEN and N18 (χ2 = 23.970; p < 0.01), the frequency of occurrence of renal comorbidity (χ2 = 23.970; p < 0.01), the frequency of family renal comorbidity in siblings (χ2 = 23.970; p < 0.01), and the frequency of migrationes (χ2 = 4.874; p < 0.01). According to psychiatry scales, the patients from the BEN group were significantly more anxious and depressive than those from the control group. Conclusion. The signs of thanatophobia were revealed in both examined groups, but significantly more in the patients with BEN than in those with other nephrologic diseases. Thanatophobia starts before dialysis, and dialysis structures it into fear of death which is in a direct connection with the basic disorder. This intensive fear may be connected with dementia and depression, but also with other mental disorders.
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