Psychological sequelae of HIV infection and AIDS: Review of empirical findings

A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease

Forty-six Chinese patients with symptomatic human immunodeficiency virus (HIV) participated in a comparative study assessing the effectiveness of cognitive-behavioral group therapy (CBT) and peer support/counseling group therapy (PSC) in relation to improving mood and quality of life and decreasing uncertainty in illness as compared to a group receiving routine treatment with no formal psychosocial intervention. The CBT group consisted of 10 subjects, the PSC group of 10 subjects, and the comparison group of 26 subjects. There was a 24% attrition rate. The intervention groups received 12 weekly sessions of therapy over 3 months. Assessment of mood states was carried out before randomization (baseline data), immediately postintervention (3-month time point) and followed-up 3 months later (6-month time point). Assessment of quality of life and uncertainty in illness was carried out before randomization and at the 6-month follow-up time point. Results indicated that the mood of the participants in the CBT group improved in terms of anger, tension-anxiety, depression, confusion, and overall mood. The quality of life in this group was significantly improved compared to the other two groups, as was uncertainty in illness. In the PSC group a worsening of psychologic functioning was observed immediately postintervention, but this picture dramatically improved at the follow-up assessment with improvements of up to 34%. Quality of life also improved over time in this group by almost 5%, but results did not reach statistical significance. This study demonstrated that psychologic interventions could decrease psychologic distress and improve quality of life in symptomatic HIV patients, indicating their use should be incorporated in the management of care of people living with HIV/AIDS.

Neuropsychiatric aspects of HIV infection among older adults

Treatment advances such as the advent of highly active antiretroviral therapy (HAART) have translated into greater life expectancy for HIV-infected individuals, which will ultimately result in a "graying" of the HIV/AIDS epidemic. In addition, older individuals are engaging in a higher rate of high risk behaviors than had been previously expected. As such, study of older HIV-infected patients, including study of the psychiatric and neurocognitive aspects of the disease, appears highly indicated. Epidemiological studies have demonstrated that HIV infection is associated with higher rates of several psychological/psychiatric disorders when compared to general population base rates. There is also a rich literature that has documented the adverse neurocognitive effects of HIV infection, ranging from subtle cognitive complaints to frank dementia, among younger adults. Although it has been hypothesized that older age may potentiate the deleterious effects of HIV infection, little is actually known, however, regarding the incidence, prevalence, course, and clinical features of HIV-associated psychiatric and cognitive dysfunction among older adults. This article provides an overview of the epidemiology and clinical manifestations of HIV-associated cognitive and psychiatric disorder across the age spectrum, with particular focus on what is known regarding the interaction of advancing age and HIV infection. Future directions for research are suggested, including basic epidemiologic study of incidence and prevalence rates of neurodisease among older HIV-infected adults as well as investigations designed to determine whether the nature, severity, course, or treatment of such disorders differs among older versus younger patients.

The application of cognitive-behavioural therapy for depression to people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS)

Over the past decade the cognitive approach to depression has received considerable attention. The impetus for this stems from empirical and theoretical reports of its efficacy in its application to the treatment of depressed individuals (Beck, 1976, 1976; Seligman, 1975; Abramson et al., 1978). This paper examines the theory and practice of cognitive behavioural therapy (CBT) and questions whether it has anything to offer clinicians working with people affected by acquired immune deficiency syndrome (AIDS) or the human immunodeficiency virus (HIV) given that it was originally developed, and has traditionally been used, to treat mood disordered psychiatric patient populations. The theory of cognitive therapy is examined with specific emphasis on Beck's contribution. Reference is made to the literature on the psychological problems experienced by people with AIDS (PWAs), and an assessment is presented of the contribution of cognitive therapy to ameliorate problems experienced by PWAs.

Attitudes toward Suicide in Patients with HIV/AIDS

This study investigated the attitudes toward suicide of HIV positive patients, a population at substantial risk for suicide. Such attitudes have not been studied, and it is quite possible that the depression and stress associated with HIV may be mediated by such attitudes. The Suicide Opinion Questionnaire, the Beck Depression Inventory, the Hopelessness Scale, and a demographic questionnaire were administered to three male samples ( n = 36 each). The first sample consisted of HIV positive gay men, with the diagnosis of AIDS or AIDS related complex (ARC). The second sample consisted of HIV negative gay men who had no symptoms for AIDS or ARC. The third sample consisted of thirty-six heterosexual males in good physical health with no evidence of AIDS, ARC, or other major medical conditions. The three samples were matched on age, ethnicity, education, and reported annual income. The three samples differed significantly on both depression and hopelessness, with HIV positive scoring highest, HIV negative scoring intermediate, and heterosexual scoring lowest. Depression correlated significantly with scores on the SOQ mental illness and cry for help scales for both HIV groups, but not for the heterosexual group. Hopelessness scores correlated significantly with the SOQ mental illness scale for the HIV negative and heterosexual groups, but not for the HIV positive group. Significant differences in attitude toward suicide between HIV positive and the other two samples were obtained on four of the SOQ scales. No significant differences were obtained between HIV negative and heterosexual respondents. These results suggest that as the HIV/AIDS entity progresses, attitudes toward suicide are altered in order to cope with the stress and to maintain cognitive balance.