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

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