|
Abstract
|
Even though the physical and mental quality of life of living kidney transplant donors has been reported to be better compared with the general population,1-3 some donors develop psychiatric symptoms, such as depression4, 5; however, few reports of donor suicide have been documented. We report a case of a living renal transplant donor who developed major depressive disorder and committed suicide.
A woman in her 70s, Mrs. A, presented to our psychiatry department with a chief complaint of depression. Apart from mild mood swings during menopause, which improved with hormone replacement therapy, she had always been cheerful and had no history of psychiatric illness. She had married in her twenties and had several children. She had a good relationship with her spouse, and their decision-making was always done in a wife-dominated manner. Her husband, Mr. B, had been diagnosed with multiple-cystic kidneys after a medical check-up 20 years previously. He was introduced to dialysis 8 years ago but suffered from pruritus owing to hyperphosphatemia. At Mrs. A's own suggestion, she donated a kidney to Mr. B and a kidney transplant procedure was performed. Three years ago, Mr. B underwent surgery for spondylolisthesis and developed a postoperative urinary tract infection, which resulted in progressive renal impairment. Around that time, Mrs. A began experiencing back pain, palpitations, and fatigue. She visited several internal medicine clinics, but the cause was unknown, and her internal medicine doctor determined that her symptoms stemmed from psychological factors.
Two months ago, Mr. B's dialysis was started again. Immediately afterward, Mrs. A became aware of her own depressed mood and anxiety. Subsequently, she was referred to our psychiatry department by her internal medicine doctor. On examination, she exhibited depressed mood, feelings of guilt, thoughts of death, sleep disturbances, anxiety, agitation, appetite loss, and delusions, such as "I ruined my husband's kidneys because of my poor management for him" and "I'm dying because I can't pass stools." She had a score of 40 on the Hamilton Depression Rating Scale (HAM-D) retrospectively, and 48 on the Center for Epidemiologic Studies Depression Scale (CES-D). No abnormalities were found in the physical examination or laboratory test results, including in her kidney function (serum creatinine 1.00 mg/dL, blood urea nitrogen 11 mg/dL) and thyroid function. Brain magnetic resonance imaging revealed no abnormalities. We diagnosed Mrs. A with "296.24 major depressive disorder with mood-congruent psychotic features" (DSM-5). ...
Language: en |