Trastornos adaptativos al medio hospitalario en pacientes con VIH / Adaptive disorders in a Hospital setting when dealing with HIV patients

Desde su inicio la infección por VIH ha estado relacionada con trastornos psicopatológicos, pero en la actualidad la prevalencia de patología psiquiátrica se encuentra significativamente elevada. Ello justifica que los problemas derivados de sus cuidados durante el proceso de hospitalización multipliquen su complejidad cuando al internamiento se asocian condicionantes emocionales y conductuales derivados de trastornos psicopatológicos, asociados al binomio infección-VIH, y que requieren estrategias de intervención específicas, individuales y consensuadas por equipos multidisciplinares expertos. En consecuencia se esgrimen las situaciones asociadas al proceso de la infección con mayor riesgo para desencadenar problemas conductuales durante la hospitalización, y se desarrollan estrategias y técnicas de intervención para detectar y abordar de forma precoz posibles conductas y comportamientos que pudieran llegar a interferir en la progresión de los cuidados y en el régimen terapéutico durante el proceso de internamiento hospitalario, ya sea de forma puntual o progresiva según sea la necesidad particular. A partir de la propia experiencia profesional en el abordaje hospitalario de este tipo de pacientes y de la participación en grupos expertos para la mejora de sus cuidados, apuntamos la necesidad de desarrollar un plan de cuidados específico que responda a sus necesidades psico-emocionales a través de una justificación teórica del planteamiento. La intervención psicológica y el apoyo emocional son las únicas vías para facilitar la percepción de control a los afectados, amortiguar el impacto emocional, maximizar el éxito del tratamiento y favorecer actitudes y conductas que propicien el afrontamiento del estado de salud y la autogestión de los cuidados. Para ello se precisa la implicación de equipos multidisciplinares que abarquen el problema desde una perspectiva bio-psico-social que aborde los problemas fisiológicos, emocionales y conductuales mediante intervenciones individuales que deben derivarse de planes de cuidados específicos(AU)

Since its start, HIV infection has been related to psychopathological disorders, but at present times, the prevalence of psychiatric pathologies lies at a significantly high level, a factor which justifies that problems derived from care of HIV infected patients during their hospitalization multiply their complexity when being kept in a hospital becomes associated with emotional and behavioral conditioners derived from psychopathological disorders associated with the HIV-infection binomially and these require specific individualized intervention strategies agreed upon by multidisciplinary teams of experts. The authors fend off situations associated with this infection’s process which have the greatest risk in order to link up behavioral problems during hospitalization and to develop intervention strategies and techniques to, in a prompt manner, detect and deal with possible behaviors which could interfere in the progress of treatment and in the therapeutic program during enforced hospitalization, be those interventions either specific one time actions or progressive actions depending on the pertinent circumstances and needs. Based on actual professional experiences in hospital situations created by these kinds of patients and by the participation of groups of experts to improve treatment given, the authors point out the necessity to develop a specific treatment plan which responds to these patients’ psycho-emotional needs by means of a theoretical justification of the proposed treatment. Psychological interventions and emotional help are the only ways to facilitate a perception of control to those affected, to reduce the emotional impact, to maximize treatment success and to promote attitudes and behaviors which enable a patient to confront his/her state of health and self-regulation of their treatment. To these ends, it is essential that a multidisciplinary team becomes involved to deal with this problem from a bio-psycho-social perspective and to include physiological, emotional and behavioral by means of individual interventions which must be derived from specific treatment plans(AU)

Trastornos psicopatológicos en pacientes VIH-SIDA / Psycho-pathological disturbance in HIV-AIDS patients

Desde su inicio, la infección por VIH ha estado estrechamente relacionada con trastornos psico-patológicos bien por el conocimiento del diagnóstico (trastornos adaptativos), por el propio virus (demencia asociada a SIDA, psicosis orgánica), por la aparición de enfermedades oportunistas (encefalopatías) o por la existencia de problemas colaterales (toxicomanías, trastornos de personalidad por condicionantes de marginalidad…). Diversos estudios muestran cómo la prevalencia de trastornos mentales en pacientes seropositivos, incluido el abuso de sustancias adictivas, presentan tasas que rondan el 50%, mucho más elevadas a las esperadas en la población general. Se determina la prevalencia de morbilidad psiquiátrica en nuestros pacientes, así como posibles factores que puedan asociarse al desarrollo de dichos trastornos mentales, mediante un estudio prospectivo de pacientes seropositivos ingresados en nuestro Servicio entre diciembre 2007 y abril 2008. Los datos utilizados fueron substraídos de los registros de Enfermería, de la historia clínica y a través de un cuestionario sociodemográfico y toxicológico anónimo y previamente validado de 13 ítems. Dicho cuestionario estaba encabezado por 7 preguntas de datos sociodemográficos de la persona encuestada, y a continuación de 6 preguntas de respuesta cerrada acerca de sus hábitos de consumo de sustancias tóxicas, grado de adherencia al TARGA, y existencia de algún tipo de seguimiento o tratamiento psiquiátrico. De los 50 casos estudiados hallamos un 44% con antecedentes de patología psiquiátrica, de los cuales un 38% estaban en tratamiento farmacológico. La incidencia de patología psiquiátrica en la muestra corrobora los datos de la bibliografía consultada. La mejora en los cuidados al paciente VIH requiere un abordaje multidisciplinar y la existencia de intervenciones psicoterapéuticas protocolarizadas a través de planes de cuidados de Enfermería específicos de patología psiquiátrica, que eviten recurrir a la valoración psiquiátrica del paciente sólo en situaciones de descompensación clínica (trastornos del comportamiento, conductas de descontrol por abuso o abstinencia, sintomatología concomitante a su patología psiquiátrica)(AU)

Since it began, HIV infection has been closely related to psycho-pathological disturbances, either upon knowing the diagnosis, an adaptive disturbance, due to the virus itself, AIDS associated dementia or organic psychosis, due to the appearance of opportunistic diseases such as encephalitis, or due to the existence of collateral problems which include drug addiction or personality disturbances due to being marginalized. Diverse studies show a prevalence of mental disturbances among HIV positive patients, including the abuse of addictive substances, which have rates near 50%, rates much higher than those expected among the general population. The authors determine the prevalence of psychiatric morbidity among our patients, as well as possible factors which can be associated with the development of the aforementioned mental disturbances by means of a prospective study on HIV positive patients treated by our service between December 2007 and April 2008. Data analyzed came from Nursing clinical files patient case histories, and by means of an anonymous social demographic and drug addiction questionnaire comprised of 13 items which were previously validated. This questionnaire started off with 7 social demographic questions related to personal data of the person filling in the questionnaire; followed by 6 closed answer questions on the interviewee’s habits consuming toxic substance, degree of adherence to TARGA, and whether or not the patient had some type of follow-up or psychiatric treatment. Of the 50 cases studied, we found 44% had previously known psychiatric pathologies, of which 38% received pharmaceutical treatment. The incidence of psychiatric pathology in our sample corroborates data found in the bibliography consulted by the authors. Improvement in treatment of HIV patients requires a multidisciplinary approach and the existence of psychotherapeutic interventions based on set protocols by means of Nursing treatment plans specifying psychiatric pathology which avoid recurring to patient psychiatric evaluation only in cases of clinical decompensation, behavior disorders, uncontrolled behavior due to abuse or abstinence, symptoms concurrent to one’s psychiatric pathology(AU)

[Psycho-pathological disturbance in HIV-AIDS patients]. / Trastornos psicopatológicos en pacientes VIH-SIDA.

Since it began, HIV infection has been closely related to psycho-pathological disturbances, either upon knowing the diagnosis, an adaptive disturbance, due to the virus itself, AIDS associated dementia or organic psychosis, due to the appearance of opportunistic diseases such as encephalitis, or due to the existence of collateral problems which include drug addiction or personality disturbances due to being marginalized. Diverse studies show a prevalence of mental disturbances among HIV positive patients, including the abuse of addictive substances, which have rates near 50%, rates much higher than those expected among the general population. The authors determine the prevalence of psychiatric morbidity among our patients, as well as possible factors which can be associated with the development of the aforementioned mental disturbances by means of a prospective study on HIV positive patients treated by our service between December 2007 and April 2008. Data analyzed came from Nursing clinical files patient case histories, and by means of an anonymous social demographic and drug addiction questionnaire comprised of 13 items which were previously validated. This questionnaire started off with 7 social demographic questions related to personal data of the person filling in the questionnaire; followed by 6 closed answer questions on the interviewee's habits consuming toxic substance, degree of adherence to TARGA, and whether or not the patient had some type of follow-up or psychiatric treatment. Of the 50 cases studied, we found 44% had previously known psychiatric pathologies, of which 38% received pharmaceutical treatment. The incidence of psychiatric pathology in our sample corroborates data found in the bibliography consulted by the authors. Improvement in treatment of HIV patients requires a multidisciplinary approach and the existence of psychotherapeutic interventions based on set protocols by means of Nursing treatment plans specifying psychiatric pathology which avoid recurring to patient psychiatric evaluation only in cases of clinical decompensation, behavior disorders, uncontrolled behavior due to abuse or abstinence, symptoms concurrent to one's psychiatric pathology.