RESUMEN
We present this medical-psychiatric case discussion to illustrate the psychodynamic aspects of nonadherence in a woman with AIDS. Our patient sustained severe, repeated abandonment and brutal emotional, physical and sexual trauma throughout her early and later childhood and adult life. Her care was considerably complicated by the sequelae of trauma including difficulty with trust and posttraumatic stress disorder. The additional problem of HIV dementia compounded the patient's nonadherence to treatment. We present a multidisciplinary biopsychosocial approach that enabled the patient to engage in both medical and psychiatric care.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/psicología , Síndrome de Inmunodeficiencia Adquirida/terapia , Seropositividad para VIH/psicología , Seropositividad para VIH/terapia , Trastornos por Estrés Postraumático/etiología , Negativa del Paciente al Tratamiento , Complejo SIDA Demencia/etiología , Adulto , Femenino , Humanos , Grupo de Atención al Paciente , Trastornos por Estrés Postraumático/diagnósticoRESUMEN
The purpose of this study was to assess the prevalence of distress, anxiety, and depression in persons with human immunodeficiency virus (HIV) infection and determine the feasibility of screening in an urban HIV primary care setting. A convenience sample of 101 patients in the waiting room of an acquired immunodeficiency syndrome clinic completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Distress Thermometer. The patient's demographic, medical, and psychiatric histories were obtained through chart review. The results of the Distress Thermometer revealed that 72.3% had a score of 5 or greater, demonstrating high distress. The results of the HADS revealed that 70.3% had high anxiety, with a score of 7 or greater. On the HADS depression questions, 45.5% had a score of 7 or greater, indicating depression. Analysis of the total HADS scores, including anxiety and depression, revealed that 53.5% had a score of greater than 15 and were experiencing significant distress. Patients with high viral loads were more likely to be distressed (P < 0.0005). Patients with high viral loads were also more likely to have higher anxiety or depression scores on the HADS. Patients who had CD4 counts higher than 500/mm(3) were less likely to be depressed. This study demonstrates a high prevalence of distress, anxiety, and depression among persons with HIV. The HADS and the Distress Thermometer showed a good correlation with each other (P < 0.0005), and these questionnaires can provide a simple and efficient method for rapid screening in an HIV clinic setting.