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 10-28: Psychological and Psychosocial IssuesWhile these issues are divided into early-, middle- and late-phase concerns, in fact any of theissues26canpicasand do occur at any phase. Discussion about some issues, particularly those thatbecome critical in the later phase, often gets postponed due to collusion on the part of providersand patients to refrain from addressing difficult topics until absolutely necessary. However,it is best to begin discussing all of these issues early in care.Early in HIV Diagnosis• Adjusting to new diagnosis of HIV seroconversion: acute vs. chronic adaptationalresponses (fear of imminent death, guilt of infecting others, exacerbationof existing psychiatric conditions, acute suicidal ideation)• Disclosure to others; informing intimate contacts, partners and children• Adapting safer sexual and drug using behaviors• Accessing appropriate HIV medical and psychiatric care• Assessing substance use and need for detox, treatment, methadonemaintanence• Accommodating to medical evaluation and assessment of levelof illness (lab results, etc.)• Establishment of health care proxy; defining those involved in the care of thepatientMiddle Phase• Accommodating work and family needs to physical and emotional impact ofillness• Dealing with learning about the nature of the illness and the potentialtreatments• Adherence issues• Decisions about working, going on disability, back-to-work issues, feelingproductive• Maintaining relationships and managing normal developmental issues in thecontext of the uncertainty of the progression of illness• Dealing with untoward effects of illness and/or treatment; e.g., medicationside effects, lipodystrophy syndrome and body image, fatigue and depressionLater Phase• Permanency planning issues• Advance directives• Existential issues; e.g., the meaning of one’s life, hope versus despair, spiritualconcerns and death anxiety, “rational suicide”• Decisions about withdrawing care at the end of life• Preparations for death246U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau