Depression was the most common reaction, although the clinical features were somewhat different between groups studied. In addition, a unique and episodic psychotic syndrome was found in four patients.

Depression and psychotic episodes seemed to reflect the psychodynamic components such as instinctual frustration, physical, familial and financial loss, dependency on a machine, sensory deprivation and the so-called fear of death and fear of life. These seemed to follow the unique features of hemodialysis and transplantation. The main defense mechanism seemed to be denial.

The possible role of psychiatrists was discussed for evaluation, treatment, and prevention of these reactions and for the support of the family and the treatment team.