AIDS-related psychiatric disorder

Psychiatric hospital staff knowledge and attitudes towards AIDS, and the impact of an in-house education seminar

A self-administered questionnaire assessing general knowledge about AIDS, including modes of transmission, methods of prevention and attitudes to the disease, was completed by staff in a psychiatric hospital after an AIDS education seminar. The data were used to assess staff knowledge of and attitudes to AIDS, and to assess the usefulness of the seminar in changing these. Responses to individual questionnaire items were examined for associations with age, sex, job description and attendance at the seminar.

Eighty-six staff members returned questionnaires, a response rate of 39%. The results showed that levels of knowledge concerning AIDS transmission and prevention were high. A significantly greater proportion of seminar attenders were aware that needles should not be recapped after taking blood samples, but when this and other knowledge and attitude responses were corrected to allow for the higher proportion of non-medical staff among the non-attenders, there were no significant differences between attenders and non-attenders.

These results suggest that an omnibus AIDS education seminar may not produce a worthwhile improvement in staff knowledge of or attitudes to AIDS.

Depressive symptoms in opiate addicts on methadone maintenance

Sixty seven opiate dependent addicts receiving methadone maintenance completed the Beck Depression Inventory. A high level of depressive symptoms was found. Eighteen (27%) scored in the moderately depressed range while thirty eight (56%) scored in the severely depressed range. There was no statistically significant association between either sex or HIV status and level of symptom reporting. The clinical implications of depressive symptoms in opiate addicts are discussed.

Tratamento de depressão em indivíduos infectados pelo HIV

A infecção pelo HIV/Aids é freqüentemente associada a transtornos psiquiátricos. Dentre eles, a depressão é o mais comum. O diagnóstico e o tratamento dos transtornos depressivos são fundamentais para melhorar a qualidade de vida desses pacientes. Esta revisão tem como objetivo sintetizar e discutir os resultados mais importantes da literatura a respeito das particularidades do tratamento dos transtornos depressivos em indivíduos infectados pelo HIV. São discutidos a epidemiologia, o quadro clínico, a influência da depressão na evolução da infecção, o tratamento farmacológico com antidepressivos, testosterona e psicoestimulantes e a interação farmacológica entre os antidepressivos e benzodiazepínicos e as drogas antivirais. Conclui-se que o tratamento antidepressivo nessa população é eficaz, seguro e não promove imunossupressão nos indivíduos afetados.

Psychiatric morbidity in sentenced segregated HIV-positive prisoners

In this comparative study with a control group of prisoners, psychiatric morbidity was measured in two groups of sentenced prisoners, each group completing the GHQ-30 and 21-item Beck Depression Inventory (BDI). Group 1 consisted of 40 segregated HIV-positive prisoners and group 2 a matched control group in the main prison who had no history of HIV seropositivity. All members of group 1 had a history of intravenous drug abuse. The mean GHQ-30 and BDI scores were significantly higher in group 1, and 90% of group 1 were psychiatric 'cases' compared with just over 42% of group 2. Levels of psychiatric morbidity present in a third group, consisting of HIV-positive prisoners who had not been segregated (prison authorities were unaware of their seropositivity) are an interesting pointer for further research.

Acquired immune deficiency syndrome: a comparison of psychiatric and general nursing staff beliefs

Objective: To assess the preparedness of psychiatric nurses to care for patients with Acquired Immune Deficiency Syndrome (AIDS). Method: Voluntary anonymous questionnaires were sent to psychiatric and general nurses in a district general teaching hospital. The behaviour, knowledge and attitudes towards AIDS of both groups were then compared with those of three experts specialising in the care of AIDS patients. Results: No inter group differences were found but a majority of nurses differed from the experts on two statements. Contrary to expert opinion nurses believed AIDS could be spread by needle stick injury and if given a choice they stated they would not volunteer to work on an AIDS ward. On controversial issues such as testing and where best to treat psychiatrically disturbed AIDS patients there was wide variation. Conclusion: While this study shows an improvement in health professionals knowledge, behaviour and attitudes towards AIDS, there remain underlying anxieties that need to be addressed with continuing education and training.

Psychiatric care for patients with HIV infection. The varying perspectives

This article reviews the literature on the classification and treatment of psychiatric morbidity associated with infection from the human immunodeficiency virus (HIV). The psychiatric disorders seen in HIV-infected patients are formulated by using one of the following four perspectives as treatment guides: 1) the syndromal or disease perspective, 2) the dispositional or personality perspective, 3) the behavioral or addictive perspective, and 4) the life story perspective.

Nurse practitioner managed care for persons with HIV infection

This exploratory study examined whether outcomes of care for HIV-infected patients are related to whether the patient's primary provider is a physician (MD) or a nurse practitioner (NP). Functional status, symptom occurrence, self management, health service use and patients' assessment of their care were evaluated for 87 HIV-infected patients in a teaching hospital outpatient setting. NP patients were three times as likely to report their health status as only fair or poor (odds-ratio = 3.06, p = .028), and reported significantly more unpleasant symptoms over a four-week period. Despite being in poorer health than patients cared for by physicians, NP patients functioned at comparable levels and used no more health care services than MD patients. NP patients reported 45 percent fewer problems with their care (p = 0.003). Findings suggest that more extensive use of nurse practitioners could safely enhance access to care for persons with HIV-related illnesses.

HIV encephalopathy presenting as hypomania

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A case of obsessive-compulsive disorder related to AIDS: psychopharmacologic treatment

It is well known that delusions, obsessions and phobic reactions may centre on items which are of current topical interest. We report a case of obsessive-compulsive disorder manifested primarily by intrusive thoughts about AIDS. The patient eventually responded to an unusual combination of medications.

The role of liaison psychiatry in an AIDS unit

The experience of a liaison psychiatry team working in the setting of an AIDS unit is described. Several clinical themes are identified which highlight crucial issues with regard to both diagnosis and management. These issues are illustrated by case histories. Discussion draws attention to the value of using a biopsychosocial model in order to understand aetiology and to formulate appropriate management. Issues related to staff involvement provide a further theme for discussion.

HIV infection: psychiatric findings in The Netherlands

A psychiatric consultation was requested in 51 in-patient cases of HIV infection. Reasons for referral included counselling, the evaluation of depressive symptoms, and the treatment of delirium. The most common DSM-III diagnoses included: delirium (n = 13), major depressive disorders (n = 12), dementia (n = 5), and adjustment disorders with depressive or anxious mood (n = 5). The psychiatric treatment of patients with HIV infection does not differ fundamentally from that of other medically ill patients with similar psychiatric symptoms. However, the psychiatric treatment of patients with HIV infection can be hampered by the fear of contagion, negative attitudes towards homosexuals and drug users, and over-identification or avoidance reactions.

Extrapyramidal reactions. Neuropsychiatric mimics in patients with AIDS

The use of neuroleptic medication as antiemetics, or in the treatment of neuropsychiatric disorders in patients with AIDS, may be associated with extrapyramidal side effects and lead to difficulty with diagnosis and management. Two cases are presented that describe severe extrapyramidal syndromes occurring in two patients with AIDS, one treated with prochlorperazine and the other with prochlorperazine and metoclopropramide. It is possible that the neuropathologic lesions found in patients with the AIDS dementia complex may pre-dispose to extrapyramidal side effects of neuroleptic medication. The differential diagnosis and treatment of delirium, dementia, depression, and extrapyramidal reactions in patients with AIDS is discussed.

AIDS as a current psychopathological theme. A report on five heterosexual patients

Five patients are described, whose common fear of contracting, or a belief of having contracted, AIDS is the presenting feature. There is a need for liaison with psychiatrists in the provision of counselling services for AIDS patients.

Viruses, immunity and mental disorder

Are viruses the cause of mental illness, or does stress or mental disorder produce impaired immunity, with increased susceptibility to infection? These two separate but not unrelated questions have been debated periodically and there has been much renewed interest recently, with increased sophistication in immunology and widespread topical concern about immunodeficiency. The neuropsychiatry of the acquired immunodeficiency syndrome (AIDS) (Snider et al, 1983; Carne & Adler, 1986; Wortis, 1986; Burton, 1987; Fenton, 1987) and the validity of a ‘post-viral fatigue syndrome’ as a clinical entity (Behan, 1983; Southern & Oldstone, 1986; Dawson, 1987; David et al, 1988) are not discussed here, but have been dealt with in the editorials and reviews cited.