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 Problems89. Forstein M. Sexual function and dysfunction in HIV disease. Part of Neuropsychiatric Curriculum developedand written by the Commission on AIDS for the American Psychiatric Association, first edition 1992. Thischapter written for the revised curriculum in press.90. Forstein 26 picas M. Psychosocial Issues in Antiretroviral Treatment. In Cournos F., Forstein M, eds. What MentalHealth Practitioners Need to Know About HIV and AIDS. Philadelphia: Jossey-Bass, 87:17-24, Fall 2000.252U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau
Chapter 11.26 picas Substance Use ProblemsJoseph F O’Neill, MD, MPH, and Peter A Selwyn, MD, MPHINTRODUCTION■ It is axiomatic in palliative care that suffering occurs in physical, emotional, practical, andspiritual domains and that each of these domains has an impact on any given symptom. 1 Althoughin many ways these domains are more complicated in patients with substance use histories,the approach to palliative care for the substance user is fundamentally the same as for anyother patient. Given the importance that substance use plays in the HIV epidemic, however, it isimportant that care providers explore, understand and address these complications. Clinicianscan often become frustrated with and alienated from substance-using patients, in whom selfdestructivebehaviors and care providers’ own negative attitudes can interfere with treatmentsuccess. However, by attending to the specific clinical issues pertaining to substance use andintegrating these into a palliative care treatment plan, providers can effectively care for thischallenging population.XIIf a patient has a history of or is currently using alcohol or illicit drugs, care providers mustknow. These issues should be, therefore, part of every history taken by members of the healthcare team and can be readily addressed in the routine primary care encounter (see Table 11-1). 2It is a mistake to raise issues of substance use only with patients who arouse suspicions or fitcertain stereotypes. Care should be taken, however, to ensure that the patient or family membersare not made to feel judged or guilty during these discussions.Table 11-1: Screening for and Diagnosis of Substance AbuseHistory of Substance AbuseSubstances usedOpioids (heroin, prescription analgesics)Stimulants (cocaine, prescription stimulants)Alcohol (beer, wine, spirits, nonbeverage sources)Sedative-hypnotics (benzodiazepines, barbiturates)Tobacco (cigarettes, chewing tobacco)Other (marijuana, hallucinogens, solvents)Routes of administrationInjection (intravenous, subcutaneous, intramuscular)IntranasalInhaledOralPattern of useAmountFrequencyDurationMost recent useNeedle-sharing or shooting gallery useU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 253
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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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IChapter 1.26 picasHIV and Palliati
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IA Clinical Guide to Supportive and
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A Clinical Guide to Supportive and
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IIIChapter 3.Assessment of Physical
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Chapter 6.26 picasPulmonary Symptom
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Chapter 8.26 picasOral ProblemsDavi
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Chapter 15.26 picasSpecial Populati
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Chapter 17.26 picasEthical IssuesLy
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Chapter 19.Palliative 26 picas Care
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Chapter 26.26 picasResourcesMagda B
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DRUGS AND THERAPIES INDEXNOTES: Ent
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