Clin Psychopharmacol Neurosci 2019; 17(2): 183-188  
Posttraumatic Embitterment Disorder in Patients with Chronic Kidney Disease
Kyungsoo Lee1, Ho Chul Song1, Euy Jin Choi1, Chi-Un Pae2,3,4, Yong Kyun Kim1,4
Departments of 1Internal Medicine and 2Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea, 3Department of Psychiatry and Behavioral Sciences, Duke Medical Center, Durham, NC, USA, 4Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to:
Chi-Un Pae, MD, PhD, Department of Psychiatry, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea
Tel: +82-32-340-2140, Fax: +82-32-340-2544, E-mail: pae@catholic.ac.kr
ORCID: https://orcid.org/0000-0003-1632-4248
Yong Kyun Kim, MD, PhD, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea
Tel: +82-32-340-2140, Fax: +82-32-340-2544, E-mail: drkimyk@catholic.ac.kr
ORCID: https://orcid.org/0000-0002-1871-3549
Received: November 8, 2017; Revised: November 14, 2017; Accepted: November 21, 2017; Published online: May 31, 2019.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Objective: Posttraumatic embitterment disorder (PTED), a subgroup of an adjustment disorder, is a feeling with anger and helplessness. Hemodialysis may be a trigger event leading to PTED. We investigated the prevalence of PTED in patients with each categorized stages of chronic kidney disease (CKD) and the association between PTED and depression and functional impairment.
Methods: Patients were categorized into three groups according to the stages of CKD (stage I-II, III-IV, and V). CKD (I-II) group was defined as estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2, CKD (III-IV) group as eGFR <60 ml/min/1.73 m2, and CKD (V) group as CKD stage V including patients ongoing hemodialysis. Patients were assessed for the prevalence of PTED, depression, and decreased quality of life by using the scale of PTED, Patient Health Questionnaire-9 (PHQ-9), and EuroQol Five Dimensional Questionnaires, Visual Analogue Scale (EQ-5D-VAS), respectively.
Results: A total of 445 patients were analyzed. The number of patients in CKD (I-II) was 166, CKD (III-IV) was 172, and CKD (V) was 107. Multivariate analysis by binomial logistic regression demonstrated that CKD (V) was significantly associated with the prevalence of PTED (odds ratio, 4.13; 95% confidence interval, 1.56-15.6; p =0.006) after adjustment for age, gender, and diabetes mellitus. Also, a significant correlation existed between PTED and EQ-5D-VAS in all stages, but the correlation was nonsignificant between PTED and PHQ-9 score in group CKD (V).
Conclusion: The findings suggest that PTED is underdiagnosed in CKD patients. Acknowledgment and diagnosis of PTED in CKD patients may lead to a better quality of life.
Keywords: Posttraumatic embitterment disorder; Dialysis; Depression; Quality of life; Chronic renal insufficiency.


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