Long-term emotional state of multiple sclerosis patients treated with interferon beta

OBJECTIVE: To assess the long-term emotional state of multiple sclerosis (MS) patients treated with interferon beta (IFNbeta) for at least four years. METHODS: Patients who had started IFNbeta therapy prior to 2000 with a baseline psychological assessment were identified and scheduled for long-term emotional assessment with the following questionnaires--the Hamilton Depression Rating Scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory. RESULTS: A total of 262 patients started IFNbeta therapy in our MS clinic within the period 1995-1999. Baseline emotional assessment was available from 246 MS patients. Long-term assessment was conducted on 234 patients. After a mean follow-up of 65 months (43-98), 52 patients (22.3%) had withdrawn from IFNbeta therapy. The comparisons, obtained from baseline and follow-up scores, showed an improvement in the depressive and anxiety symptoms of patients who adhered to IFNbeta treatment. Logistic regression analysis indicated that an increase in physical disability and the presence of depressive symptoms at baseline were best predictors for long-term depressive symptoms. CONCLUSIONS: The present results support the absence of emotional worsening in MS patients treated with IFNbeta for a long period of time. Increased disability and the presence of baseline depressive symptoms predicted the presence of depressive symptoms at follow-up.     

Depression, distress, lymphocyte subsets, and human immunodeficiency virus symptoms on two occasions in HIV-positive homosexual men.

We evaluated the extent to which depressive disorders, psychiatric distress, and psychosocial stressors are related to three measures of human immunodeficiency virus (HIV) illness, both cross-sectionally and during a 6-month period, in a community sample of 124 HIV-positive homosexual men. The dependent variables are immune status measured by CD4 and CD8 cell subsets, number of signs and symptoms commonly associated with HIV infection, and a cumulative index of HIV illness stage. We chose to focus on CD4 cell count because it is the immune marker most closely linked to the clinical consequences of HIV infection. We found no relationships between the independent variables and immune status or illness stage. The HIV-positive men who were depressed or distressed or who reported more life stressors had no greater immunosuppression or more advanced illness stage than did the others, either concurrently or across occasions. We did find a suggestive pattern of association between depressive disorders, distress, and stressors and the number of HIV-related symptoms, which warrants further study.     

Nature of depression in patients with HIV/AIDS

OBJECTIVE: Existing research suggests that the rate of depressive illness and depressive symptoms are high in people living with HIV/AIDS, but investigations on the causes of depression provide conflicting results. Social, psychological and biological factors have all been suggested as possible causes of depression in people living with HIV/AIDS. The suggestion that depression may be the result of the neurotropic effects of the virus on the central nervous system leading to an 'organic' or secondary depression has major implications in the treatment of HIV/AIDS. The aim of the current study was to further investigate the nature and underlying aetiology of depression in people living with HIV/AIDS. METHOD: One hundred and twenty-nine people living with HIV/AIDS recruited for the study from outpatients clinics and primary care settings completed a range of self-report symptom measures including the Beck Depression Inventory (BDI), SF-36, SPHERE and a personality measure, the NEO Personality Inventory (NEO-PI). They also completed a battery of neuropsychological tests (CANTAB) and a structured clinical interview (SCID-DSM-IV). Medical and sociodemographic data were also recorded. RESULTS: Approximately one-third scored > or = 14 on the BDI and 27% met criteria for a current 'mood disorder' on the SCID. Depressive symptoms were strongly related to personality style, having a past psychiatric history and current stressful psychosocial situation. There was no association between depression and HIV disease status. There was no evidence in this study cohort of a distinct subtype of 'organic' or secondary depression. CONCLUSIONS: These results suggest that at least for 'well' people living with HIV/AIDS, there is no distinct subtype of depression and early treatment approaches can be modelled on those used for other non-HIV groups. Further longitudinal studies will be required to dissect out the multiple factors underlying depression in HIV/AIDS.     

Psychosocial risk factors of HIV morbidity and mortality: findings from the Multicenter AIDS Cohort Study (MACS)

Despite the use of laboratory markers in estimating HIV prognosis, significant variation in the natural history of HIV-1 infection remains unexplained. Recent studies suggest psychosocial risk factors have important prognostic significance in HIV disease. The objective of the present study was to examine the prognostic influence of age, general intellectual functioning, and emotional distress across the spectrum of HIV disease progression. The study sample was drawn from the Multicenter AIDS Cohort Study (MACS), a 13-year, prospective study of HIV-seropositive men recruited from four study centers across the country. The participants were 1,231 HIV-seropositive MACS participants, followed from baseline (median 8/15/87) to the end of the observation period (12/15/98). HIV disease progression was evaluated with respect to three outcome measures: (1) number of years from baseline testing to the first AIDS defining illness (progression to AIDS), (2) years from baseline to HIV-dementia (progression to dementia), and (3) years from baseline to death (survival). The influence of psychosocial risk factors on outcome measures was evaluated using survival analyses. General intellectual functioning, age, and somatic symptoms of depression, were found to be significant predictors of HIV disease progression and survival. Older age at baseline was associated with a more rapid progression to dementia and death. Lower Shipley IQ estimates were associated with a more rapid disease progression (AIDS and dementia) and shortened survival. Somatic symptoms of depression were associated with shortened survival. In addition, age, IQ, and somatic symptoms of depression, had an additive effect with an increase in the number of risk factors associated with accelerated disease progression and shortened time to death. These findings remained consistent, despite controlling for baseline CD4 and HIV medication use. Psychosocial cofactors are important in understanding HIV disease progression. Methods for estimating HIV prognosis may become more reliable if psychosocial factors are considered. Future research will clarify if psychosocial risk factors reflect central nervous system integrity, brain reserve capacity or mediate morbidity and mortality through social economic status, access to health care and other social correlates.     

Psychosocial Risk Factors of HIV Morbidity and Mortality: Findings from the Multicenter AIDS Cohort Study (MACS)

Despite the use of laboratory markers in estimating HIV prognosis, significant variation in the natural history of HIV-1 infection remains unexplained. Recent studies suggest psychosocial risk factors have important prognostic significance in HIV disease. The objective of the present study was to examine the prognostic influence of age, general intellectual functioning, and emotional distress across the spectrum of HIV disease progression. The study sample was drawn from the Multicenter AIDS Cohort Study (MACS), a 13-year, prospective study of HIV-seropositive men recruited from four study centers across the country. The participants were 1,231 HIV-seropositive MACS participants, followed from baseline (median 8/15/87) to the end of the observation period (12/15/98). HIV disease progression was evaluated with respect to three outcome measures: (1) number of years from baseline testing to the first AIDS defining illness (progression to AIDS), (2) years from baseline to HIV-dementia (progression to dementia), and (3) years from baseline to death (survival). The influence of psychosocial risk factors on outcome measures was evaluated using survival analyses. General intellectual functioning, age, and somatic symptoms of depression, were found to be significant predictors of HIV disease progression and survival. Older age at baseline was associated with a more rapid progression to dementia and death. Lower Shipley IQ estimates were associated with a more rapid disease progression (AIDS and dementia) and shortened survival. Somatic symptoms of depression were associated with shortened survival. In addition, age, IQ, and somatic symptoms of depression, had an additive effect with an increase in the number of risk factors associated with accelerated disease progression and shortened time to death. These findings remained consistent, despite controlling for baseline CD4 and HIV medication use. Psychosocial cofactors are important in understanding HIV disease progression. Methods for estimating HIV prognosis may become more reliable if psychosocial factors are considered. Future research will clarify if psychosocial risk factors reflect central nervous system integrity, brain reserve capacity or mediate morbidity and mortality through social economic status, access to health care and other social correlates.     

Depression in people living with HIV/AIDS attending primary care and outpatient clinics

OBJECTIVE: Our aim was to gain an estimate of the rate of depressive disorder in patients with HIV/AIDS attending general practice and to investigate factors associated with depression. A further objective was to determine the ability of non-mental health medical practitioners to detect depressive symptoms in their patients with HIV/AIDS. METHODS Participants comprised 322 persons living with HIV/AIDS ( (PLWHA); 13 females, 309 males; mean age 41.4, SD = 8.9) who were recruited from four general practice clinics specializing in HIV medicine and from an infectious diseases clinic. Medical, psychiatric and sociodemographic data were obtained. In addition, participants completed the Inventory to Diagnose Depression (IDD), a self-report measure to detect depression. RESULTS: Twenty-two per cent of the sample met criteria for a current Major Depressive Episode (DSM-IV defined) on the IDD. Overall, there was moderate agreement between treating doctors' diagnosis of depression and patients' self-report of depressive symptoms. A multivariate model indicated that being in a current relationship was associated with lowered odds of depression (OR = 0.43; CI = 0.23-0.81). The factors strongly associated with increased odds of depression were a past history of illicit drug use (OR = 2.98; CI = 1.60-5.54) and a diagnosis of 'stress' by treating doctors (OR = 5.65; CI = 2.50-12.77). HIV-related medical variables such as immune function, use of antiretro-viral medication and duration of HIV infection were not associated with depression. CONCLUSIONS: There was a high rate of self-reported depression in this group of PLWHA which was also recognized by treating clinicians. Being in a relationship appeared to afford protection against depression while having a history of illicit drug use and current 'stress' were highly associated with depression. Interestingly, HIV-related medical variables including laboratory markers of HIV disease, duration of illness and antiretroviral medication regimen were not related to depression.     

Are immunological markers,social and personal resources,or a complaint-free state predictors of progression among HIV-infected patients?

Predictors of disease progression were studied in 89 asymptomatic HIV-infected patients who were prospectively evaluated for psychosocial variables and the development of clinical symptoms over a period of 2 years. The subjects were assessed for symptoms, laboratory measures, demographic variables, social and personal resources, mental status, alcohol, nicotine and drug use, sexual activity and risk behaviour, and sexually transmitted diseases. After 1 year, 17% of the patients had developed HIV-associated symptoms (symptomatic disease or AIDS), and after 2 years, 32% had developed symptoms or had died. In the multivariate analyses, the baseline CD4 count was the only significant predictor of disease progression during both observation periods. Psychosocial measures did not predict the progression of HIV infection.     

Longitudinal improvement in psychomotor processing speed is associated with potent combination antiretroviral therapy in HIV-1 infection

This longitudinal natural history study aimed to assess the pattern and durability of neurocognitive benefits of progressively more potent combination antiretroviral therapy in HIV-1 infection. A cohort of 141 homosexual or bisexual men were assessed semiannually for CD4 count, HIV RNA viral load, medical and depressive symptoms, and a neuropsychological test battery, including psychomotor speed, verbal memory, and executive function. In a mixed-effects model, increasingly potent antiretroviral therapy was associated with improvement in tests of psychomotor processing speed. This study contributes to the growing literature documenting the longitudinal benefit provided by potent antiretroviral therapy for neuropsychological function, particularly psychomotor processing speed, in patients with HIV illness.     

Burden of relatives and predictors of burden. Baseline results from the Munich 5–year–follow–up study on relatives of first hospitalized patients with schizophrenia or depression

In the present study, part of the Munich 5-year follow-up study on key relatives of first-hospitalized schizophrenic and depressive patients, baseline results with respect to relatives' burden and predictors of burden are presented. Basing on a transactional stress model the following hypothesis was tested: the impact of the patients' illness on their relatives' stress outcome is moderated by the psychosocial resources of the relatives. Stress outcome was measured in terms of objective and subjective burden, well-being, self-rated symptoms and global satisfaction with life. Potential moderating variables included age and gender, generalized stress response and illness-related coping strategies, beliefs of control,perceived social support,personality factors, expressed emotion and life stressors. A total of 83 relatives, whose ill family members had been hospitalized in the Department of Psychiatry of the Ludwig-Maximilians-University of Munich for the first time, participated in the study. Findings did not entirely support the hypothesis. On the one hand, relatives' stress outcome was independent of the objective stressors (severity of the illness, kind of symptoms, level of psychosocial functioning at admission). On the other hand, burden was significantly associated with several psychosocial resources and dispositions of the relatives. Multivariate linear regression analyses indicated that expressed emotion, emotion-focused coping strategies and generalized negative stress response are the most relevant predictors of burden. It is argued that a multidimensional approach in burden assessment is necessary and has relevant implications for improving family intervention strategies.     

Prospective follow-up study lasting 2 years in patients with panic disorder with and without depressive disorders

Summary A group of 52 patients presenting at an outpatient unit for anxiety disorders were included consecutively in a prospective 2-year follow-up study. Patients were administered to a structured interview for DSM-III-R diagnoses, a follow-up interview (LIFE), and various other ratings. Sociodemographic and illness-history characteristics, levels of anxiety and depressive symptoms, as well as psychosocial impairment, were evaluated at baseline and follow-up and compared between patients with panic disorder only and patients with panic disorder and concomitant depressive disorders at index assessment. Cross-sectional and longitudinal differences between patients with panic disorder only and patients with panic disorder and concomitant depression have been found, indicating that patients with comorbid conditions are more severely ill and have a less favorable outcome. For the total sample, however, the 2-year outcome was better than that reported in many other follow-up studies.     

Psychosocial adjustment of people with epilepsy in Hong Kong

PURPOSE: In light of the issues associated with the psychosocial adjustment of people with epilepsy that have been widely reported, this study examined these issues within a Chinese cultural context. METHODS: Fifty patients with epilepsy completed The Washington Psychosocial Inventory, the Coping Inventory for Stressful Situations, and a questionnaire that assessed their psychosocial difficulties and coping styles. Multiple regression procedure was used to examine the strength of various medical and social factors in predicting the psychosocial adjustment problems of these participants. RESULTS: Social factors, such as self-perception and coping strategies, were more powerful predictors of psychosocial adjustment in people with epilepsy than the medical factors associated with epilepsy. CONCLUSIONS: These findings showed that psychosocial maladjustment is a significant issue for people with epilepsy in Hong Kong. The emerging importance of social factors as predictors of psychosocial adjustment in epilepsy, as compared with medical factors, highlights the need for developing tailored counseling therapy and social support groups for people with epilepsy.     

Cognitive-Behavior Therapy with Adult Patients with Epilepsy: A Controlled Outcome Study

The present study evaluated the efficacy of group cognitive-behavior therapy for the alleviation of psychosocial problems and reduction of seizures with adult epileptic patients. Twenty-seven outpatients were randomly assigned to one of three groups: Cognitive-Behavior Therapy, Supportive Counseling (attention-placebo control), and Waiting list (no treatment control). The major outcome measures used were: patient's, neurologist's, and therapist's global ratings of psychological adjustment, patient's target complaints and weekly seizure frequency, patient's and neurologist's ratings of seizure control, the Minnesota Multiphasic Personality Inventory, the Washington Psychosocial Seizure Inventory, and the Beck Depression Inventory. No significant differences were found among the three groups on these measures except for therapist's global ratings of psychological adjustment, on which both the Cognitive-Behavior Therapy and Supportive Counseling groups improved significantly after therapy, but the Waiting List control group did not. Overall, little support was found for the efficacy of group cognitive behavior therapy (eight 2-h weekly sessions) for the reduction of psychosocial difficulties or seizures. Implications of the present findings are discussed, with the need for further controlled outcome research stressed.     

The prevalence and characteristics of suicidality in HIV/AIDS as seen in an African population in Entebbe district, Uganda

ABSTRACT: BACKGROUND: Suicidality in HIV/AIDS is not only a predictor of future attempted suicide and completed suicide, it is also associated with poor quality of life and poor adherence with antiretroviral therapy. This paper examines the prevalence and correlates of suicidality in HIV/AIDS in the African nation of Uganda. METHODS: A cross-sectional study was undertaken among 618 respondents attending two HIV clinics in semi-urban Uganda. A structured questionnaire was used to collect data on demographic, social, psychological and clinical factors. Correlates of suicidality were assessed using mulitvariable logistic regression. RESULTS: Prevalence of 'moderate to high risk for suicidality' (MHS) was 7.8% and that of life-time attempted suicide was 3.9%. Factors associated with MHS at univariate analysis were: female gender, food insecurity, increasing negative life events, high stress score, negative coping style, past psychiatric history, psychosocial impairment, diagnoses of post-traumatic stress disorder, generalised anxiety disorder and major depressive disorder. Factors independently associated with MHS in multivariate models were female gender, increasing negative life events, a previous psychiatric history, and major depressive disorder. CONCLUSIONS: These results are in agreement with the stress-vulnerability model where social and psychological stressors acting on an underlying diathesis (including previous and current psychiatric morbidities) leads to suicidality. These results identify potential targets to mitigate risk through treatment of psychiatric disorders and promoting greater adaptation to living with HIV/AIDS.     

Quality of life and its correlates in HIV/AIDS male outpatients receiving highly active antiretroviral therapy in Taiwan

Long-term care of human HIV and AIDS cases has raised quality of life (QoL) issues. The aim of this study was to identify QoL in HIV/AIDS male outpatients receiving highly active antiretroviral therapy (HAART) and its correlates in Taiwan. In total, 41 HIV/AIDS male outpatients receiving HAART yet presenting few symptoms of infection, were recruited for the study. Their QoL levels were measured with the Taiwan version of the Short Form of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The relationships between QoL and demographic characteristics, social support, negative stressors, depression, characteristics of HIV infection, attitude toward HIV infection, and adverse effects of HAART, were examined. The results of the analysis reveal that multiple factors affect QoL for HIV/AIDS male outpatients receiving HAART, including severity of depression, deterioration of work function, inconvenience resulting from medication schedules and medical appointments, lack of social support, negative stressors, and adverse effects of HAART. The results provide screening factors so that clinicians can intervene to improve the QoL for their HIV patients.     

Emotional adjustment in amyotrophic lateral sclerosis (ALS)

Despite the devastating motor impairment, a significant number of patients with amyotrophic lateral sclerosis (ALS) maintain a good psychosocial adjustment. Here we investigated whether this is specific for ALS or a more general characteristic of terminal disease. Psychosocial adjustment was investigated in 30 ALS patients, 29 cancer patients in palliative treatment and 29 age-, gender- and level of education-matched healthy controls. Subjective quality of life (sQoL), degree of depressive symptoms and coping were evaluated as measures of psychosocial adjustment. Personality factors were described. ALS and cancer patients showed a good psychosocial adjustment. Subjective QoL and depression did not differ significantly. Both patient groups presented a good sQoL. The level of mild depressive symptoms in both patient groups was similar and none showed clinically relevant depression. ALS patients expressed fewer active coping strategies than cancer patients which were explained by gender differences. Both patient groups showed comparable psychosocial adjustment to their disease. Overall, in terminally ill patients the psychological response to the prognosis is not associated with neurobiological changes (e.g., associated with subclinical deficits in ALS) or with physical decline.     

Adjustment to illness and dropout of chemotherapy

The study compares the adjustment to illness of a group of 53 cancer patients who dropped out of chemotherapy with a matched group of 53 cancer patients who completed their treatment. The patients were treated in five oncological institutes in Israel. We found differences both in the Psychosocial Adjustment to Illness Scale (PAIS) and Brief Symptom Inventory Scale (BSI). In both scales we found significant differences indicating that the degree of adjustment and the psychosocial distress of patients who dropped out of treatment was worse than that of patients who completed treatment.     

Psychosocial and behavioral interventions for chronic medical conditions

PURPOSE OF REVIEW: This paper critically reviews recent studies that have used behavioral or psychosocial interventions aimed at preventing type 2 diabetes mellitus, cardiovascular disease and HIV/AIDS as well as the psychosocial management of cardiovascular disease, HIV and cancer. RECENT FINDINGS: Behavioral (lifestyle) interventions can decrease risk of type 2 diabetes mellitus and cardiovascular disease. Psychosocial interventions have proven efficacy for alleviating distress in patients medically treated for cancer, cardiovascular disease and HIV/AIDS. These interventions may also help to prevent HIV infection, and improve medication adherence in HIV/AIDS. SUMMARY: Behavioral and psychosocial interventions are useful in preventing some chronic diseases and for alleviating distress in patients who have been medically treated for diseases such as cancer, cardiovascular disease and HIV/AIDS. Findings regarding the effects of psychosocial interventions on disease processes, morbidity and mortality are not yet well established and require appropriate clinical trials.     

Parent caregiver adjustment to cancer of an adult child

OBJECTIVE: The objective of this study is to assess which contextual variables (parent caregiver, social support, age and gender) and objective variables (type of diagnosis, stage of illness and patient distress) affected the adjustment to illness of parent caregivers of an adult married ill child. METHOD: Forty-one parent caregivers of an adult married cancer-diagnosed child completed a questionnaire that measured psychological adjustment (Brief Symptom Inventory, BSI), psychosocial adjustment to illness (Psychosocial Adjustment to Illness Scale, PAIS) and social support (MSSPS). RESULTS: Preliminary findings indicate that social support and the patient's psychological distress were the main effects on the parents' psychological adjustment to the illness. CONCLUSION: A psychosocial intervention program for parents is needed so as to reduce their distress arising from the stress of the illness.     

The adjustment to illness in patients with generalized anxiety disorder is poorer than that in patients with end-stage renal disease

Although generalized anxiety disorder (GAD) is associated with significant occupational disability, it has, however, received little attention with regard to adjustment to illness. Subjects included 102 chronic dialysis (CD) patients, 58 kidney transplant (KT) patients, and 42 GAD patients. The evaluations included the Psychosocial Adjustment to Physical Illness Scale (PAIS), the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D). Preanxiolytic treatment GAD patients had the most anxiety and depressive symptoms, followed by CD patients and KT patients. KT patients and anxiolytic-treated GAD patients showed similar anxiety and depressive symptoms. These two groups were both better than CD patients. However, the adjustment to illness of GAD patients after treatment is still worse than the other two groups (108.0+/-16.3(GAD), 102.0+/-14.5(CD), 81.4+/-22.2(KT); P<.001). The CD patients had a high rate of psychiatric morbidity and a low rate of psychiatric intervention (3%); however, end-stage renal disease (ESRD) patients received only one assessment while the GAD group received two in this study. In light of the chronicity of GAD, pharmacological treatment is not sufficient by itself. Clinicians should keep these in mind when treating either GAD or ESRD.