Symptoms,Symptom Management,and Psychological Morbidity Among Persons with HIV Disease

Abstract

For the clinician caring for patients in some phase of symptomatic HIV disease, patients' current level of adaptation and potential to sustain a sense of well-being are critical. Symptoms of anxiety and depression raise concern, and must be assessed for their severity and enduring qualities. Are these expressions evidence of moods that fluctuate over time even within a given day? Or are they reflective of full-blown syndromes enduring over time? Finally, are these reported and observable symptoms signs of current or imminent psychiatric disorders? Too frequently, episodes of anxiety and depression in persons with life-threatening illness are misdiagnosed where transient moods are given clinical relevance and syndromes are underestimated. Specificity in assessment is needed to derive the most appropriate intervention program. This problem in the context of primary care services to persons with HIV illness can lead to too much concern about temporary distress and minimization of moderate to severe levels of anxiety and depression. People with AIDS (PWAs) must cope with multiple complications while anticipating a shortened lifespan. Emotional distress is common and may be organically based, idiopathic, and/or reactive. The relationship of somatic well-being and subjective emotional distress needs attention since the severity of physical debilitation and heightened risk of psychological problems seem to be correlated in this population. Predicting increased anxiety and dysphoric moods at crisis points in the illness draws attention to the role of individuals' cognitive appraisals of their symptoms, judgments of self-efficacy, and outcome expectancies. Symptom severity and perceived control over symptoms are interlocking phenomena capable of influencing emotional distress in these patients.