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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This cohort study examined the impact of phytotherapy (PT; traditional herbs) on neuropsychiatric aspects of HIV disease progression to antibody immunodeficiency syndrome (AIDS), CD4 counts, and viral load in adult patients in Harare, Zimbabwe. This is a community-based and nonintervention cohort study. The study was conducted in and around Harare City from June 1996 to May 1998. One hundred and five volunteers participated in the study. They were seen at the baseline and then followed up on a 3-month basis. The volunteers were interviewed, underwent physical examinations, and had blood drawn for laboratory tests, including the chest X-rays. The outcome measures were: prevalence of mental disorders and depressive symptoms, diagnosis of AIDS, and changes in CD4 cell counts and plasma HIV-I RNA concentrations. Instruments used were the Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), Structured Interview Diagnosis of Dementia According to the DSM-IV (SIDAM), and Centre for Disease Control and Prevention (CDC) criteria as measurement tools. The findings were that patients on the PT had a mean (S.D.) age of 34.5 (7.4) years, whereas those on conventional therapy were a bit older with a mean (S.D.) age of 36.4 (6.6) years, range 19-55 years. The overall prevalence of psychiatric disorders according to the DSM-IV diagnostic criteria at the baseline was 44.8% (n=47, 95% CI=35.3-54.3) and by the end of the 6 months follow-up was 36% (n = 18, 95% CI = 23-49). The relative risks of psychiatric diagnoses were less in patients on PT (P = .046), including the diagnoses of depression (P = .035), than those on conventional therapy. Mean levels of a reported symptom of suicidal thoughts according to the MADRS were lowest in patients on PT than those on conventional therapy (F=5.44, P=.022). Finally, PT is protective against psychiatric disorders in our patients. However, our findings did not support HIV-I disease progression to AIDS in these patients.
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PMID:Neuropsychiatric aspects of HIV disease progression: impact of traditional herbs on adult patients in Zimbabwe. 1199 94

We aimed to investigate the prevalence of ulcerative sexually transmissible diseases (STDs) and hepatitis in crack users. We interviewed 435 crack users on site in crack houses in Houston, Texas and took blood for laboratory analysis. There was evidence of syphilis infection in 13%, herpes simplex virus-2 (HSV-2) in 61%, HIV in 12%, hepatitis B in 52%, and hepatitis C in 41% of cases. On DSM-III-R criteria, 12% were crack abusers and 84% crack dependent: over half reported previous treatment. Forty per cent reported also injecting. Sexual behaviour indicated a mean of 2.4 partners in the past month for men, 3.7 for women. Sexual behaviour was largely vaginal, although women also reported more than twice the level of oral sex of men. Significant multivariate predictors for HIV and hepatitis B and C were previous reported STD and injecting drug use (including sharing needles), while female gender for syphilis and HSV-2, and additionally condom use for HSV-2, were significant risks. These data confirm high rates of STDs in a crack house population as inferred from previous clinic-based and community studies, and the link between STDs, injecting and HIV. The high rates of STDs found should lead to considering STDs and substance abuse to be dual diagnoses in crack users and the integration of STD diagnosis and treatment into crack outreach and treatment programmes.
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PMID:Sexual behaviour, STDs and drug use in a crack house population. 1203 74

The objective of this study was to obtain accurate estimates of the prevalence of psychiatric disorder in the population represented by the HIV Costs and Services Utilization Study cohort. We constructed logistic regression models to predict DSM-IV diagnoses of depression, generalized anxiety disorder, panic, and dysthymia among a subsample of the HCSUS cohort who in separate interviews completed the CIDI-SF and the full CIDI diagnostic interview. Diagnoses were predicted using responses to the CIDI-SF as well as other variables contained in the baseline and first follow-up interviews. Resulting regression equations were applied to the entire baseline and first follow-up samples to obtain new estimates of the prevalence of disorder. Compared to estimates based on the CIDI-SF alone, estimates obtained from this procedure provide a more accurate representation of the prevalence of the presence of any one of these four psychiatric disorders in this population, yielding more correct classifications and a lower false-positive rate. Prevalence rates reported in this study are as much as 16% lower than rates estimated using the CIDI-SF alone, but are still considerably higher than estimates for the general community population.
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PMID:Re-estimating the prevalence of psychiatric disorders in a nationally representative sample of persons receiving care for HIV: results from the HIV Cost and Services Utilization Study. 1245 97

To date, the authors know of no prospective studies of sustained-release bupropion in depressed HIV-seropositive patients. The purpose of this study was to evaluate the efficacy and tolerability of sustained-release bupropion in 20 depressed HIV-positive adult outpatients. Twenty outpatients with HIV spectrum illness, a DSM-IV-diagnosed major depressive disorder confirmed with the Structured Clinical Interview for DSM-IV, and Mini-Mental State Examination scores >20 were recruited into a 6-week, open-label, flexible-dose study of sustained-release bupropion (100-300 mg/day). Twelve patients (60%) responded to sustained-release bupropion at a mean dose of 265 mg/day. Five patients (25%) discontinued study participation secondary to adverse events. Preliminary findings suggest that sustained-release bupropion is effective for the treatment of depression in HIV-positive patients, regardless of HIV clinical staging. Furthermore, it appears to be well tolerated in patients with AIDS-related medical conditions.
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PMID:A prospective trial of sustained-release bupropion for depression in HIV-seropositive and AIDS patients. 1261 34

This article describes psychiatric and substance dependence comorbidities, lifetime rates of infectious disease, and reported high-risk sexual behaviors for methamphetamine-dependent, gay and bisexual men at entry to outpatient drug abuse treatment in Los Angeles. Participants' self-reports of high-risk sexual and drug use behaviors and of history of infectious disease status were correlated with diagnostic information from 155 Structured Clinical Interviews for the DSM-IV (SCID). A total of 82 participants met criteria for lifetime depressive disorders; 44 participants met criteria for lifetime anxiety disorders. Compared to those without psychiatric diagnoses, significant differences were observed in lifetime prevalence of sexually transmitted infections among those who have generalized anxiety disorder (higher rates of genital gonorrhea), specific phobia and major depressive disorder (higher rates of oral gonorrhea), social phobia (higher rates of syphilis) and bipolar disorder, type I (higher rates of HIV). Differences in infectious disease prevalence did not correspond to significantly different rates of high-risk sexual behaviors. Findings indicate that gay and bisexual men seeking outpatient treatment for methamphetamine dependence are likely to experience psychiatric comorbidity and to have high rates of infectious disease, including HIV, syphilis and gonorrhea.
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PMID:Psychiatric and substance dependence comorbidities, sexually transmitted diseases, and risk behaviors among methamphetamine-dependent gay and bisexual men seeking outpatient drug abuse treatment. 1282 59

In this European multicenter intervention study 117 persons were examined who took part in group programs to improve coping with the HIV-infection. Psychological measures were taken at four times before, during and after the intervention. These were psychological symptoms (SCL-90-R), Coping (TSK), Locus of Control (KKG), Quality of Life (MOS-HIV), and physical health. Psychopathology (DSM-III-R) and neuropsychological deficits were assessed at baseline. The study is designed to investigate, along with the effectiveness of the intervention, differences between participating homosexual men and drug users as well as to discuss HIV as a chronic disease. The program has proven efficiency to enhance psychological and physical wellbeing and to support participants' coping with HIV. Drug users report less psychopathology and more improvement during the intervention. References for the organization of group programs with these subgroups are made.
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PMID:[EUROVIHTA Project--specific intervention program for HIV infected patients to support the coping process with this chronic illness]. 1284 65

Although antiretrovirals can prolong life, medication adherence also poses a constant challenge for HIV-infected individuals because the success of antiretroviral regimens demands nearly perfect adherence to medications. This paper describes the psychiatric and social barriers to adherence in a convenience sample of HIV-positive clients in methadone treatment in the Bronx, New York. The study sample was part of a national study of HIV treatment adherence and health care utilization among triply diagnosed populations, the HIV/AIDS Treatment Adherence Health Outcomes and Cost Study. The triply diagnosed study sample is defined here as HIV-infected individuals who screened into the study with at least one psychiatric diagnosis in addition to opioid dependence on agonist therapy (methadone treatment) and at least one substance use diagnosis. Interviewers utilized modified versions of the Structured Clinical Interview for DSM-IV Disorders (SCID-I), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), and the Addiction Severity Index (ASI-Lite), among a battery of Cost Study instruments. Results showed that within this sample, borderline personality disorder was significantly associated with nonadherence to HIV medications. A related finding showed a significant relationship between serious social/family problems and nonadherence. These findings build on previous research on the impact of psychiatric illness on HIV medication adherence and suggest that psychiatric assessment and treatment options be linked to adherence interventions.
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PMID:Psychiatric and social barriers to HIV medication adherence in a triply diagnosed methadone population. 1474 57

The HIV epidemic has been consistently associated with injection drug use and crack cocaine, but alcohol problems in HIV-infected persons are less well described. Our objectives were 2-fold: (1) to assess the prevalence of alcohol problems in HIV-infected patients initiating medical care; and (2) to determine the positive predictive value of the CAGE questionnaire for alcohol abuse or dependence in HIV-infected patients. Between July 1997 and October 2000, we assessed a consecutive series of patients who were establishing primary care for HIV infection (clinic sample), using an established alcohol screening test, the CAGE questionnaire. In addition, we enrolled other HIV-infected patients, including some of the clinic sample, who had two or more positive responses to the CAGE questionnaire into a longitudinal cohort (cohort sample), performed a diagnostic interview for lifetime history of alcohol abuse and dependence, and determined the positive predictive value of CAGE for alcohol diagnoses. In the clinic sample (n = 664), 42% (276 of 664) had two or more positive responses to the four CAGE questions. In the cohort sample (n = 141), 95% (134 of 141) met DSM-IV criteria for diagnosis of lifetime alcohol abuse or dependence. For patients initiating HIV primary care, a history of alcohol problems is very common. The CAGE questionnaire identifies a lifetime history of alcohol abuse or dependence in HIV-infected patients. Routine screening for alcohol problems should be performed in all patients entering HIV medical care and the CAGE questions are useful in this setting.
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PMID:Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire. 1501 2

The purpose of this study was to examine the bereavement experience, psychiatric morbidity, and suicidality in bereaved men and women living with HIV. HIV+ women (n = 31) who reported a loss in the recent 12 months were case matched to bereaved HIV+ men (n = 62) on the basis of lifetime histories of major depression. Study participants were examined for grief reactions, psychiatric morbidity, mood symptomatology, and suicidality using the Texas Revised Inventory of Grief Revised, Structured Clinical Interview for DSM-III-R, the Hamilton Depression and Anxiety Rating, and the Diagnostic Interview Schedule for Suicide. Bereaved HIV+ women presented with intensified bereavement responses, a higher prevalence of current generalized anxiety disorder, and elevated thoughts and gestures of suicide and when compared to HIV+ men. In conclusion, bereaved women living with HIV may be at increased risk for bereavement complicated with psychiatric morbidity and thoughts of suicide. It is critical that adequate mental health support services be available to this growing risk group of bereaved individuals.
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PMID:Gender, AIDS, and bereavement: a comparison of women and men living with HIV. 1505 32

Addressing mental health concerns of HIV-positive individuals is an important component of providing quality HIV care. Mental health intake information from patients with HIV can be an important source of data to complement existing research on HIV and mental health because the intake information contains concerns that are both from the perspective of the patients and are significant enough to bring them into treatment. The current study describes the mental health intake information of HIV-positive men who have sex with men (MSM) at an urban community health clinic over a 1-year period. This information included presenting problems, current symptoms from a symptom checklist, ratings of impairments in functioning, and client histories (e.g., substance abuse, emotional, physical, and sexual abuse, previous treatment). It also included clinicians' Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses of the participants, and recommended treatments. Depression was the most prevalent presenting problem (58.1% of clients), followed by anxiety (38.2%). Consistently, depression (96.3%) and low energy (78.2%) were the most frequently endorsed symptoms on a symptom checklist, followed by anxiety (69.2%). HIV-specific problems also played a large role both directly, as a presenting problem, and indirectly as they related to such concerns as relationship issues. Axis I diagnoses included adjustment disorders (50.0%), major depressive disorder (21.4%), and dysthymia (a less severe but more chronic depression) (8.9%). This review highlights the mental health issues that HIV-positive MSM feel are significant enough to require treatment. Because mental health is a key component of overall quality of life, HIV providers who work with MSM can use these data to increase awareness of the types of mental concerns that are most distressing to this population.
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PMID:Mental health concerns of HIV-infected gay and bisexual men seeking mental health services: an observational study. 1563 61


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