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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective case-control study was performed to compare the patterns of psychiatric illness and treatment in 70 patients referred to the psychiatric liaison service from the HIV/AIDS team in a London teaching hospital with 70 age- and sex-matched controls referred for psychiatric assessment from general medical and surgical wards or out-patient clinics. Organic, mood, adjustment and personality disorders were the most common primary diagnoses. The rate of referral in the HIV group was five times that in the control group. The prevalence of each group of diagnoses was not significantly different between the HIV and control groups, except in the case of alcohol dependence (15/70 (control) v. 3/70 (HIV), p = 0.005). Forty-four per cent of the HIV group and 30% of the control group fulfilled DSM-III-R criteria for a secondary diagnosis of non-alcohol psychoactive substance abuse. A diagnosis of borderline personality disorder was made more often in the HIV group. The high frequency of psychoactive substance abuse in both the HIV and control groups has important implications for the provision of psychiatric services.
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PMID:A controlled comparison of HIV and general medical referrals to a liaison psychiatry service. 818 80

The neuropsychiatric manifestations of HIV disease include neurobiologic and psychobiologic phenomena. The former consist of primary CNS complications caused directly by HIV, and include cognitive disorders (mild neurocognitive disorder and HIV-associated dementia) and other CNS diseases such as myelopathy and the demyelinating neuropathies; and secondary disorders (principally deliria) occasioned by opportunistic infections, neoplasms, cerebrovascular events, and the effects of metabolic derangements and medications. The latter (psychobiologic) phenomena reflect efforts to cope with various nodal, or transition points, in HIV disease; such points of transition include time of serostatus determination, adaptation to asymptomatic seropositivity, response to early medical symptomatology, and later transition to frank AIDS. Anxiety symptoms and various efforts to cope with anxiety (e.g., denial, anger, withdrawal, hypochondriacal preoccupation) all can punctuate these transition points. Additionally, there may be reactivation of long-standing psychopathology (e.g., depression) in seropositive individuals who tend to belong to a group that has an elevated prevalence of pre-infection psychiatric disorder. These interacting neurobiologic and psychobiologic phenomena pose challenges to the psychiatrist who must develop a good understanding of the medical aspects of HIV infection, as well as the neuropsychiatry of AIDS. In this way psychiatric physicians can play an important role in early identification of neuropsychiatric complications, assist the medical team to anticipate emotional and behavioral disturbances, and develop treatment plans that maximize our ability to help those with HIV infection achieve the best possible quality of life.
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PMID:Natural history of neuropsychiatric manifestations of HIV disease. 819 Jun 64

The present study determined lifetime and current psychiatric functioning in a sample of homosexual or bisexual men at various stages of human immunodeficiency virus (HIV) infection in order to address several questions regarding the relationship between psychopathology and HIV infection. HIV+ asymptomatic or symptomatic and HIV- homosexual or bisexual men completed self-report measures of psychological and health functioning and participated in structured diagnostic interviews. Additional information regarding HIV-related life events and their potential relationship to onset of disorder and family history of psychiatric disorder were obtained. A high lifetime prevalence of affective and substance use disorder was found, with almost one half of the sample meeting criteria for both disorders. Lifetime affective disorder diagnosis was associated with a positive family history of affective disorder. HIV-related events were most closely associated with onset or recurrence of affective disorder compared with other disorders. Low current rates of psychiatric disorder and levels of emotional distress were found, with no differences in degree of psychiatric adjustment across stage of infection. We conclude that the lifetime prevalence of certain categories of psychiatric disorder is high in both HIV+ and HIV- homosexual samples. Increased rates of psychiatric disorders do not appear to be a consequence of HIV infection. However, episodes of illness, particularly affective disorder, may develop following an HIV-related event such as confirmation of infection. Although symptomatic subjects have more somatic difficulties, there appears to be no relationship between stage of illness and level of emotional distress.
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PMID:Psychopathology in human immunodeficiency virus infection: lifetime and current assessment. 833 32

Chronically mentally ill women of reproductive age pose major ethical dilemmas for mental health professionals if the patient does not accept contraception. Ethically questionable responses have ranged from letting the patient continue at risk of pregnancy out of a respect for her autonomy to manipulating or coercing the patient into using contraception. A third course of action assumes that mentally ill women exhibit both chronically and variably impaired autonomy with limitations in decision-making ability manifested in varying degrees over time. 3 case histories illustrate these issues. A 38-year-old schizophrenic woman wanted to become pregnant and was having unprotected intercourse. It was questionable whether the patient could give informed consent or understand contraceptive options. This impaired autonomy might lead a psychiatrist to act paternalistically to forestall a pregnancy. An alternative to this response would be to improve the patient's capacity to participate in the informed-consent process by treating underlying factors which pose barriers to the exercise of autonomy. If impairment is too severe for this treatment, beneficence-based obligations to potential children may override concerns for the patient's autonomy. In the second case, a 30-year-old schizophrenic woman was admitted in active labor in a psychotic state. Her baby was put in foster care. When her psychosis cleared, she refused to discuss birth control. The reproductive risks encountered by chronically mentally ill pregnant women can not be predicted with certainty and are not serious enough to constitute reasons to control the mother's decision-making process. In this case, an alternative approach may be to offer only reversible methods of birth control and provide information about HIV and other sexually transmitted diseases. In a hypothetical case, a 24-year-old schizophrenic woman consented to receive a contraceptive implant at the end of a hospitalization. When she regressed into a psychotic state, she requested that the implant be removed. Her doctors chose to honor the decision she made while she was not acutely psychotic and did not remove the implant. Because the risks the patient runs without the contraceptive are preventable, reversible, or uncertain, the clinician may not be justified in every case in refusing to honor a request by a patient even when she is severely psychotic. Removal of the device may relieve the patient of anxiety, even if the anxiety is delusional. The frustration involved with these problems may lead clinicians to accept any decision made by a patient, even if the principle of autonomy is thus inappropriately applied. An awareness of the variable nature of chronic mental illness, on the other hand, may help clinicians avoid a paternalistic approach. This requires the support of hospitals and clinics which, unfortunately, sometimes override ethical considerations because they must operate with a shortage of staff and resources. With contraceptive implants now available, mental health facilities should develop guidelines which address the unique ethical issues involved in their use.
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PMID:Respecting the autonomy of chronic mentally ill women in decisions about contraception. 835 6

The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. A computerized medical encounter data base, with frequencies of primary care visits and with diagnoses for each visit, was linked to the cohort study data base that contained information on patients' demographic characteristics, serologic status, and CD4+ T-lymphocyte counts. Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program. Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.
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PMID:Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program. 839 79

Recent data suggest that the homeless and those with chronic mental illness may be at increased risk for HIV infection. A review of the recent literature reveals insufficient rigorously collected data to identify with confidence any particular subgroup of chronically mentally ill patients at increased risk. Nonetheless, it seems reasonable to suspect that those with acute psychosis, a history of substance abuse, or a history of sexual abuse may be at higher risk. Conversely, some data currently support the conclusion that homeless persons are at increased risk for infection due to human immunodeficiency virus (HIV). Clinicians of all disciplines should be aware of these findings and be particularly vigilant when patients are members of both aforementioned groups. Future research should focus upon improving service delivery to the homeless and mentally ill, particularly with regard to sex education and substance abuse intervention. Also, continued research into causal influences of homelessness will ultimately lead to more definitive intervention.
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PMID:Risk of HIV infection in the homeless and chronically mentally ill. 845 64

The relationship between psychological problems and human immunodeficiency virus HIV/AIDS risk-taking behaviors was examined among 834 daily opioid users entering methadone treatment programs. A composite measure of psychological dysfunction was created using depression, anxiety, and hostility scales. This measure was found to be significantly related to needle risk in terms of injecting with used equipment, sharing of drug paraphernalia, and sharing with strangers. Psychological dysfunction was also related to sexual risk taking in terms of number of partners, unprotected sex with other injection drug users, and trading sex. Use of cocaine was significantly related to all measures of injection and sex-related risk taking; use of speedball (heroin and cocaine) was significantly related to use of dirty equipment and sharing of paraphernalia. The implications of study findings for AIDS prevention programming are discussed.
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PMID:Psychological dysfunction and HIV/AIDS risk behavior. 855 3

The authors reviewed the medical records of both mentally ill and non-mentally ill patients in a clinic for the homeless population of New Orleans. The records of all psychiatric patients (n = 52) and a randomly selected comparison group (n = 236) of clinic patients without mental illness were chosen for review. Five of the 52 homeless mentally ill who were tested for HIV had a positive test (9.6%), as did 7 of the 129 homeless people without mental illness (5.4%). Regarding TB, only 5 of the 29 mentally ill tested for TB were PPD positive (17.2%), as compared to 34 (29.3%) of the non-mentally ill, a strong trend (r = 0.11, p = 0.09). Differing trends were found regarding HIV and TB in the two homeless groups under study. Further work with a larger sample is needed to determine the factors, if any, which facilitate the spread of HIV and inhibit that of TB.
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PMID:HIV, TB, and mental illness in a health clinic for the homeless. 869 11

The CDC National AIDS Hotline provides confidential HIV-related information and referrals to anonymous callers, twenty-four hours a day. As part of a continuing quality improvement assessment of caller informational needs, 302 randomly selected anonymous overnight calls to the Hotline were evaluated for mental health-related content. Of 302 calls, 34 calls (11.3%) were mental health-related, in that callers spoke about specific mental health-related topics or requested mental health referrals, and 14 calls (4.6%) included signs or symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) potentially indicative of mental illness. The results suggest that training in recognizing and referring mental health calls might be useful for Hotline workers. The results also serve as a reminder for all health care professionals and organizations of the potential for overlap between patients' mental health-related needs and patients' HIV-related needs.
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PMID:Mental health-related calls to the CDC National AIDS Hotline. 870 39

The associations between cognitive functioning, depression questionnaire results, and diagnosed psychiatric disorders were examined among 85 HIV-1 infected patients at different stages of systemic infection and 39 seronegative controls. An affective scale and a somatic scale of the Beck Depression Inventory (BDI) were used to measure depression. Psychiatric disorders before or after the diagnosis of seropositivity were evaluated. The patients with symptomatic HIV-1 infection (AIDS related complex, AIDS) reported more somatic symptoms of depression than the subjects with asymptomatic infection or the controls, whereas psychological depression and psychiatric disorders were unrelated to the severity of HIV-1 disease. Psychiatric disorders diagnosed during HIV-1 disease were slightly associated with poor verbal memory only among symptomatic patients. Impaired visual memory showed an association with depressive mood and with psychiatric disorders preceding the diagnosis of seropositivity which suggests that factors other than HIV-1 may explain these subjects' poor visual memory.
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PMID:Cognitive deficits and emotional disorders in HIV-1 infected individuals. 912 87


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