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1.
Arch Gen Psychiatry ; 55(5): 452-7, 1998 May.
Article in English | MEDLINE | ID: mdl-9596048

ABSTRACT

BACKGROUND: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms. METHODS: Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIV-positive patients. Treatment adherence was monitored. RESULTS: Subjects randomized to interpersonal psychotherapy (n = 24) and supportive psychotherapy with imipramine (n = 26) had significantly greater improvement on depressive measures than those receiving supportive psychotherapy (n = 24) or cognitive behavioral therapy (n = 27). Similar results appeared in the completer subsample. CONCLUSIONS: Depressive symptoms appear treatable in HIV-positive patients. Interpersonal psychotherapy may have particular advantages as a psychotherapy for patients who have experienced the significant life events of HIV infection.


Subject(s)
Depressive Disorder/epidemiology , Depressive Disorder/therapy , HIV Seropositivity/epidemiology , Imipramine/therapeutic use , Psychotherapy/methods , Adult , Ambulatory Care , CD4 Lymphocyte Count , Cognitive Behavioral Therapy , Combined Modality Therapy , Comorbidity , Depressive Disorder/drug therapy , Female , HIV Seropositivity/immunology , HIV Seropositivity/psychology , Humans , Life Change Events , Male , Psychiatric Status Rating Scales , Risk Factors , Treatment Outcome
2.
Compr Psychiatry ; 38(3): 146-54, 1997.
Article in English | MEDLINE | ID: mdl-9154370

ABSTRACT

The primary purpose of this study was to assess the prevalence of major psychiatric disorders in human immunodeficiency virus-positive (HIV+) men with acquired immune deficiency syndrome (AIDS)-defining conditions. Secondary goals were to identify correlates of distress and psychopathology, and to determine whether there is a gradient of distress associated with progressive HIV illness. One hundred twelve men with AIDS-defining conditions, 61 HIV+ men without AIDS, and 84 HIV-seronegative gay men were assessed. Measures included the Structured Clinical Interview for DSM-IV (SCID), Hamilton Rating Scale for Depression (HAM-D), and other dimensional measures of distress and outlook, as well as laboratory markers of HIV stage, including HIV RNA viral load assays. Rates of major depression, consistent with other findings, were in the 5% to 10% range. Mean scores on dimensional measures of distress and outlook were within the "not depressed" range and did not increase despite increasing HIV illness severity. However, rates of dysthymia were elevated among men with CD4 cell counts less than 500, and the cumulative rates of any current axis I depressive disorder for three of the four study groups were in the range of 15% to 20%. The strongest correlates of dimensional measures of distress were current HIV symptoms and social support, and to a lesser extent, a lifetime history of major depression and current use of antidepressants and/or anxiolytics. Overall, most men displayed effective adaptation to illness, but a significant minority experienced moderate psychological distress, which warrants consideration by health providers who serve this population.


Subject(s)
Acquired Immunodeficiency Syndrome/complications , Depressive Disorder/complications , Depressive Disorder/diagnosis , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/psychology , Anxiety Disorders/complications , Anxiety Disorders/diagnosis , CD4 Antigens , Cross-Sectional Studies , Depressive Disorder/psychology , Homosexuality, Male , Humans , Male , Prevalence , Prospective Studies , Psychiatric Status Rating Scales , Quality of Life , RNA, Viral , Severity of Illness Index , Social Support , Substance-Related Disorders/complications , Substance-Related Disorders/diagnosis
3.
Am J Psychiatry ; 152(10): 1504-9, 1995 Oct.
Article in English | MEDLINE | ID: mdl-7573591

ABSTRACT

OBJECTIVE: The authors present preliminary data from two treatment modalities of a randomized clinical trial in which they compared 16-week interventions of interpersonal psychotherapy to supportive psychotherapy. METHOD: HIV-positive patients who were not acutely medically ill and had scores of 15 or higher on the Hamilton Depression Rating Scale were randomly assigned to one of four treatment modalities. They were assessed by the Hamilton scale and Beck Depression Inventory at 8 and 16 weeks. Most subjects who underwent either interpersonal psychotherapy (N = 16) or supportive psychotherapy (N = 16) were male, gay or bisexual, white, and college educated. RESULTS: Results of last-observation-carried-forward and completer analyses showed that scores on the Hamilton scale and Beck Depression Inventory decreased significantly for both treatments. Differential improvement for interpersonal psychotherapy appeared by midtreatment (week 8) and persisted at termination. CONCLUSIONS: This is the first controlled study of individual psychotherapies for depressed HIV-positive patients. Results suggest that a specific antidepressant psychotherapy, interpersonal psychotherapy, has advantages over a supportive therapy.


Subject(s)
Depressive Disorder/therapy , HIV Seropositivity/complications , Psychotherapy/methods , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Educational Status , Follow-Up Studies , Homosexuality, Male , Humans , Male , Psychiatric Status Rating Scales , Sex Factors , Treatment Outcome
4.
AIDS Educ Prev ; 6(5): 403-11, 1994 Oct.
Article in English | MEDLINE | ID: mdl-7818976

ABSTRACT

This study, with the objective of examining voluntary self-disclosure of HIV infection after repeated counseling, was conducted in a private setting, and designed to operate in conjunction with HIV testing. Counseling was provided at entry, and then at 3 months, 6 months, and every six months thereafter. The study was conducted among 129 HIV-positive adults; the primary risk factor was history of: males having sex with males (n = 104); injection drug use (n = 19); or heterosexual contact (n = 6). Results showed that after a mean of 2.3 years since initial HIV-positive notification, 29 percent of subjects had not disclosed the HIV infection to any present partner, and 30 percent to any past sex partner. Casual sex and lower perceived social support were significantly associated with nondisclosure. The authors conclude that even after repeated individual counseling and at least several months to inform others, about one-third of the sexually active subjects did not disclose their HIV infection to any present sex partner. Clinical and public health implications are covered.


Subject(s)
HIV Infections/psychology , HIV-1 , Self Disclosure , Sex Counseling , Sexual Partners , Adolescent , Adult , Aged , Chi-Square Distribution , Female , HIV Infections/epidemiology , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Risk-Taking , Sex Counseling/statistics & numerical data , Sexual Partners/psychology , Socioeconomic Factors , Time Factors
5.
J Am Dent Assoc ; 124(9): 51-4, 1993 Sep.
Article in English | MEDLINE | ID: mdl-8409027

ABSTRACT

We prospectively examined self-disclosure of HIV infection by 129 men and women to dentists and physicians. After an average of 2.3 years since initial HIV-positive notification and repeated individual counseling, only 53 percent of subjects had told their dentists of HIV infection compared to 89 percent who had told their physicians. This high rate of non-disclosure despite extensive counseling raises concern about effectiveness of education alone in promoting voluntary self-disclosure. Our findings further support recommended universal precautions.


Subject(s)
Dentist-Patient Relations , Disclosure , HIV Infections/psychology , Truth Disclosure , Adolescent , Adult , Aged , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Patient Compliance , Patient Education as Topic , Prospective Studies , Risk Factors , Universal Precautions
7.
Med Clin North Am ; 76(1): 99-106, 1992 Jan.
Article in English | MEDLINE | ID: mdl-1727543

ABSTRACT

Despite the complexity and magnitude of the psychiatric disturbances associated with HIV illness, a good deal is understood about their clinical presentation. Techniques for psychopharmacologic and psychotherapeutic management have been well established and are readily available. The expertise developed for management of psychiatric disturbances in other medical illnesses applies quite well to HIV-related conditions. Although the HIV epidemic challenges us with new difficulties, our experience with other illnesses provides us with a basis to respond.


Subject(s)
Acquired Immunodeficiency Syndrome/complications , Mental Disorders/complications , Humans , Mental Disorders/diagnosis , Mental Disorders/therapy , Psychotherapy , Psychotropic Drugs/therapeutic use
8.
AIDS ; 4(2): 145-52, 1990 Feb.
Article in English | MEDLINE | ID: mdl-2328097

ABSTRACT

To determine the emotional impact of serological testing for HIV, 218 physically asymptomatic adults were evaluated in a confidential clinical setting 2 weeks before HIV test notification, immediately before and after notification, and 2 and 10 weeks later. All received extensive pre- and post-test counseling. The 179 seronegatives reported one or more HIV risk behaviors: homosexual intercourse (n = 111), heterosexual intercourse with possibly infected partners (n = 62), intravenous drug use (n = 20). Immediately after notification, seronegatives had significant decreases in visual analogue scale (VAS) measures of anxiety, depression, fear of getting AIDS, and fear of having infected others. Reductions were sustained at both follow-up assessments and were complemented by significant reductions on standardized self-reported measures of anxiety (Spielberger State Anxiety Inventory, SAI), depression (Beck Depression Inventory, BDI), and psychiatric symptoms (Brief Symptom Inventory, BSI) as well as by clinical ratings of depression (Hamilton Depression Rating Scale, HDRS). Of 39 seropositives, 35 had homosexual risk behaviors, seven had been intravenous drug users (IVDUs; four of whom were homosexual men), and one was a female partner of an IVDU. Immediately after notification, VAS measures of their anxiety were not significantly increased, and at 10 weeks after notification, their VAS measures of distress and mean scores on BDI, SAI and BSI were significantly lower than at entry. Their HDRS ratings were not significantly increased.


Subject(s)
AIDS Serodiagnosis/psychology , HIV Seropositivity/psychology , Adult , Aged , Anxiety , Bisexuality , Depression , Female , Homosexuality , Humans , Male , Middle Aged , Risk Factors , Sexual Behavior , Stress, Psychological , Substance Abuse, Intravenous , Time Factors
9.
Am J Psychiatry ; 147(1): 89-93, 1990 Jan.
Article in English | MEDLINE | ID: mdl-2293794

ABSTRACT

To identify the diagnostic characteristics and counseling needs of individuals at risk for acquired immune deficiency syndrome (AIDS), standardized DSM-III-R diagnoses were given to 207 physically asymptomatic adults when they sought serological testing for the human immunodeficiency virus (HIV). The subjects had high lifetime rates of mood disorders. Even after the 20 subjects with intravenous drug use as a risk factor were eliminated, lifetime rates of nonalcohol substance dependence were also high. These findings suggest that even before they are notified of HIV test results, many individuals at perceived risk for AIDS may be vulnerable to future depression and nonintravenous drug abuse.


Subject(s)
AIDS Serodiagnosis , HIV Seropositivity/complications , Mental Disorders/epidemiology , Adult , Aged , Catchment Area, Health , Counseling , Depressive Disorder/complications , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Female , HIV Seropositivity/diagnosis , Homosexuality , Humans , Longitudinal Studies , Male , Mental Disorders/complications , Mental Disorders/diagnosis , Middle Aged , Prevalence , Psychiatric Status Rating Scales , Risk Factors , Substance-Related Disorders/complications , Substance-Related Disorders/diagnosis , Substance-Related Disorders/epidemiology
10.
Am J Psychiatry ; 143(10): 1222-7, 1986 Oct.
Article in English | MEDLINE | ID: mdl-3766784

ABSTRACT

The authors examined the symptoms of 35 patients with schizotypal personality disorder. In contrast to the suggestion, based on studies of nonclinical, familial samples, that patients with schizotypal disorder are best characterized by the negative symptoms of social isolation and impaired functioning, they found that the positive symptoms of odd communication, ideas of reference, magical thinking, and illusions were equally valid discriminators of their clinically based group of patients. The findings argue against the idea that schizotypal personality disorder be redefined in the revision of DSM-III (DSM-III-R) to emphasize negative symptoms and suggest that clinical samples of schizotypal patients may differ from familial samples.


Subject(s)
Schizotypal Personality Disorder/diagnosis , Adult , Ambulatory Care , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/genetics , Borderline Personality Disorder/psychology , Diagnosis, Differential , Female , Hospitalization , Humans , Male , Manuals as Topic/standards , Schizotypal Personality Disorder/genetics , Schizotypal Personality Disorder/psychology
12.
Proc Natl Acad Sci U S A ; 74(1): 111-4, 1977 Jan.
Article in English | MEDLINE | ID: mdl-319454

ABSTRACT

Low concentrations of the dye tetraiodofluorescein activate native aspartate transcarbamylase (aspartate carbomoyltransferase, carbomoylphosphate:L-aspartate carbomoyltransferase, EC 2.1.3.2), while high concentrations inhibit the enzyme's activity [Jacobsberg, L. B., Kantrowitz, E. R. & Lipscomb, W. N. (1975) J. Biol. Chem. 250, 9238-9249]. This dye is now shown to produce similar effects upon a modified form of aspartate transcarbamylase produced by Escherichia coli grown in a culture medium supplemented with thiouracil. Significantly, the ATP-induced activation is reduced in the modified form of the enzyme to the same extent as is the tetraiodofluorescein-induced activation. Thus, a relationship is demonstrated between the internal mechanisms by which ATP and tetraiodofluorescein activate aspartate transcarbamylase.


Subject(s)
Aspartate Carbamoyltransferase/metabolism , Fluoresceins/pharmacology , Adenosine Triphosphate/pharmacology , Allosteric Regulation/drug effects , Aspartate Carbamoyltransferase/biosynthesis , Enzyme Activation/drug effects , Escherichia coli/enzymology , Structure-Activity Relationship , Thiouracil/pharmacology
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