The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

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A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 10: Psychiatric ProblemsAnxiety DisordersAnxiety is a common concern. Brief periods of anxiety directly related to specific eventsusually respond to support and help in coping with the specific problem. Anxiety disorders,however, 26 can picas impair overall functioning and the capacity for self-care. 67Anxiety often coexists with depression and substance abuse. Anxiety disorders in HIV/AIDSpatients range up to 40%. However, there is no clear association between specific types of anxietyand HIV status or stage of disease. Diagnosis of anxiety is important as anxiety can affect thecapacity of the patient to take in information, plan ahead, or adhere to a treatment plan.Health care providers must rule out biological causes—presented in Table 10-21—for anxietysymptoms. Once biological causes have been ruled out, it is important to diagnose the anxietydisorder correctly in order to determine the treatment.Table 10-21: Differential Diagnosis of AnxietyMedical causes of anxietyHypoxia due to respiratory infectionsHypoglycemiaCNS lesionsHyperthyroidismPheochromocytomaAdrenal insufficiencyMedications• Antiretrovirals• Antidepressants• Psychostimulants (methylphenidate,dextroamphetamine)• Neuroleptics (haloperidol, risperidone,chlorpromazine)• Antituberculous (isoniazid, cycloserine)• Antihypertensives (reserpine, hydralazine)• Sympathomimetics (ephedrine,epinephrine,phenylephrine, phenylpropanolamine, dopamine,pseudoephedrine)• Steroids (prescribed for hypogonadal states/usedfor body-building)• Nicotinic acid• Thyroid medications• Theophylline/ aminophylline• Cold or sinus medications with ephedrineAcute withdrawal from substances of abuseExcessive caffeine (coffee, tea, soft drinks, chocolate)Herbal compounds (gingko, ginseng, ma huang,ephedra, guarana)Cognitive impairment with anxiety andfear of losing one’s mind232U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 10: Psychiatric ProblemsTable 10-21: Differential Diagnosis of Anxiety (continued)Psychological stressorscausing anxiety26 picasFear of painFear of rejection by loved onesFear of isolationFinancial distress, job insecurityStigmatizationHousing concernsChild care, permanency placementDisease unpredictabilityLoss of control over bodily functions, increaseddependencyDeath of another person with HIVFear of death and dying due to acute change inmedical statusGeneralized Anxiety Disorder (GAD)Generalized anxiety disorder (GAD) is diagnosed when another specific cause of anxiety cannotbe found and the person suffers from persistent and significant anxiety that impairs function.GAD may or may not be associated with specific life events. Many patients may have been sufferingwith GAD prior to the diagnosis of their HIV disease, but develop a more profound anddisabling anxiety disorder as they enter treatment. Likewise, chronic substance users may unmaskGAD when they initiate sobriety as a result of being diagnosed with HIV. Major depressionwith anxiety must always be considered in the differential diagnosis of GAD.XPanic DisorderPanic symptoms can be terrifying to the person and can, in severe or chronically untreatedsituations, lead to suicidal ideation and attempts. Many patients are worked up for cardiovascular,neurological, or respiratory disorders before a diagnosis of panic disorder is made. A medicalevaluation should rule out alcohol withdrawal, cocaine or other stimulant abuse, overuse ofcaffeine, arrhythmia, hyperthyroidism, asthma, pneumonia, or the use of herbal compoundsthat include ephedra, gingko, ginseng, ma huang, or guarana. Signs and symptoms of panicdisorder are described in Table 10-22.Table 10-22: Panic DisorderPanic DisorderDiagnosed by the following(1) recurrent panic attacks (see below); and(2) at least one of the attacks has been followed byone month or more of one or more of the following:• Persistent concern about having additionalattacks• Worry about the implications of the attack or itsconsequences (i.e. losing control, having a heartattack, “going crazy”); or• A significant change in behavior related to theattacksU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 233
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DedicationA Clinical Guide to Suppo
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Lynn A Jansen, RN, PhDAssistant Res
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TABLE OF CONTENTSPart IChapter 1Cha
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Chapter 6.26 picasPulmonary Symptom
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Chapter 8.26 picasOral ProblemsDavi
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Chapter 14.26 picasCulture and Care
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Chapter 17.26 picasEthical IssuesLy
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Chapter 19.Palliative 26 picas Care
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DRUGS AND THERAPIES INDEXNOTES: Ent
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