Handbook of Consultation-Liaison Psychiatry by Hoyle Leigh;Jon Streltzer

Author:Hoyle Leigh;Jon Streltzer [Streltzer, Hoyle Leigh;Jon]
Language: eng
Format: epub
Published: 0101-01-01T00:00:00+00:00

19.1.2.4 Noncompliant and Aggressive Behavior

This is the most vexing psychiatric problem facing the nephrology staff. To understand why noncompliant behavior seems to be so commonplace, one needs to understand two factors: the skewing of the population that develops renal failure, and how patients handle chronic illness. Diabetes and hypertension patients who are noncompliant with treatment are prone to kidney failure, as are patients with addictive disorders. Therefore, renal failure patients are not a cross section of the general population; rather, this illness is more prevalent in the noncompliant and, to a degree, in antisocial people. Also, patients with chronic medical illnesses often fail to stick to their diets or to comp[ly with other aspects of their medical management.

The management of noncompliant patients is difficult because of the nature of the problem. It is important to help patients understand that failure to adhere to the medical regimen can result in repeated hospitalization and a decrease in life expectancy. When noncompliance involves missing dialysis runs and aggressive behavior, it is important for staff to maintain minimal tolerance for it. Again, early on, it is important for the staff to make clear that any aggressive behavior that affects the safety of staff and other patients will be treated as a police matter. Further, chronic offenders and patients who repeatedly miss dialysis runs may be transferred to other units.

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