PSYCHIATRIC ASPECTS OF THE HIV / AIDS AND PSYCHOLOGIC MANAGEMENT OF AIDS PATIENTS

Author: Dr. P. Rama Krishna M.D., D.Y, F.I.P.S.; Neuropsychiatrist


G.P. Institute / Hospital of Alternative Therapies & Research Centre, Hyderabad-20, INDIA.

*    Mental Health Clinicians have had a major role in the health care system in the efforts to cope with

      HIV related  disorders.
*    Neuropsychiatric complications occur in at least 50% of patients
*    Psychiatric syndroms associated with AIDS patients needs treatment with drugs and Psychotherapy.
*    Mental health professionals and mental health organisations have used their influence to educate people about

      societal effects of HIV related disorders and need to change in behaviors that are generally held to be private,
      such as sexual and substance using behaviours.

PSYCHIATRIC SYNDROMES
1.    Dementra
    *    A poor prognostic sign
    *    50%-75% of Patients with dementia die within six months
2.    Delirium
3.    Anxiety Disorders
    *    Generalized Anxiety disorders
    *    Post-trumatic stress disorders(PSTD)
    *    Obessive compulsive diorders(OCD)
4.    Adjustment Disorders
    *    Occur in 5-20% of patients
    *    More in military recruits and prison inmates
5.    Depressive Disorders
    *    4%-40% of HIV infected patients suffer from depression
6.    Substance - Abuse
7.    Suicide
    *    RISK FACTORS
    *    Having friends who died of AIDS
    *    Recent notification of HIV Seropositive
    *    Inadequae social / Financial support
    *    Relapses
8.    Mania

PRE-TEST COUNCELING
1.    Discuss meaning of positive result; clarify distortions
2.    Discuss meaning of Negative rsult
3.    Be available to discuss the patient's fear and concerns
4.    Discuss why the test in necessary
5.    Explore patient's reactions to positive result-intercence in a potentially catastrophic reaction.
6.    Explore past reactions to serve stresses.
7.    Explore high risk behaviors.
8.    Allow the patient to ask questions

POST-TEST COUNSELING
1.    Interpretaion of Test result; clarify distortions.
2.    Recommendation for prevention of transmission
3.    Recommendation on the follow up of sexual partnersand needle contacts
4.    If test result is positive - Recommendation against donating Blood, Sperum or organs
5.    Appropriate psychological support

COMMON-THEMES
*    Shock Diagnosis
*    Fear of Death
*    Social consequences
*    Grief over potential losses
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Depressionn - Hopelesness - Angor - Frustraion - Guilt - Obsessive Themes
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TREATMENT OF PSYCHIATRIC SYNDROMES
1.    Drugs                 :     ANTIPSYCHOTICS
                        ANTI DEPRESSANTS
                        ANXIOLYTICS

2.    Psychotherapy             :     Individual psychotherapy
                        Short term
                        Supportive psychotherapy
                        Cognitive Behavior Therapy(CBT)

3.    Public Education Compaigns    :    Safe sex guidelines
                        Educate about HIV substance abouse

4.    Involvement of Signification
    others                 :     FAMILY
                        Lover
                        Friends
Number of patients seen at G.P. Institute / Hospital of Alternative Therapies & Research centre, Hyderabad

Year2000                                                    Year2001(Upto October)
Total No.of patients      :    214             Total No.of patients               :     118
Anxiety Disorders          :     45.79%       Anxiety Disorders                   :     40.67%
Depression                    :     28.97%       Depression                           :     23.72%
Mania                          :     0.93%         Mania                                  :     NIL
Schizophrenia                :     0.46%        Schizophrenia                        :     3.38%
Dementia                      :     NIL              Dementia                             :     NIL
Nil psychiatric                :     23.83%       Nil psychiatric                       :     32.70%

TREATMENT
All the patients are treated for HIV/AIDS by the following:

Ayurvedic drugs, manufactured by G.P. Pharmaceuticals, Hyderabad(A.P)
AVALMIC-I        KAPHAYOG
AVALMIC-II        MEDHAMRUTHA

Simultaneously the patients, who are suffering from psychiatric disorders, are treated by Antipsychotics, Antidepressants, Anxiolyics, Counseling, Psychotherapy, Family therapy given for all patients.

Patients improved with the above treatment and results are encouraging. There are no side effects during the combined treatment (both Allopatheic and Ayurvedic)

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