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

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 3: Assessment of Physical Symptomstion, but rather, unrelieved pain. In addition, social problems may be behind such behaviors,and occasionally a behavior listed as aberrant may occur in a patient who simply does not adhereto the norms of social conventions. For example, a patient may borrow medications fromanother26withoutpicasobtaining a physician’s prescription and although this is listed as an aberrantbehavior it may be an isolated event occurring in the absence of serious problems.Table 3-5: Differential Diagnosis for Aberrant Drug-Related BehaviorsCategories are not mutually exclusive• Addiction (substance dependence disorder)• “Pseudo-addiction”• Psychiatric disorder associated with impulsive or aberrant drug-taking• Personality disorder, including borderline and psychopathicpersonality disorders• Depressive disorder• Anxiety disorder• Encephalopathy with confusion about appropriate therapeutic regimen• Criminal intent• Other including “normal” or “reasonable” behavior, especially for behavior“less” suggestive of additionSource: Passik SD, Portenoy RK. Substance abuse issues in palliative care. In Berger A, ed. Principles and Practices of SupportiveOncology. Philadelphia: Lippincott-Raven Publishers, 1998. Reproduced with permission. Copyright 1998.It must be recognized that undertreatment of pain is currently a more common problem in mostclinical settings (including the HIV clinical setting) than addiction and substance abuse.Nonetheless, consideration and monitoring of aberrant behaviors can provide clinicians withimportant information that can assist in assessing and treating symptoms and defining problems.The management of patients who have problems with substance abuse, and/or engage in aberrantdrug-related behaviors for other reasons “necessitates a comprehensive approach that recognizesthe biological, chemical, social, and psychiatric aspects of substance abuse and addiction and48, 49provides practical means to manage risk, treat pain effectively and ensure patient safety.”SYMPTOM MEASUREMENT IN CLINICAL PRACTICE■ Recently it has been recognized that the use of symptom measurement raises the possibilityof improving outcomes through careful and ongoing monitoring of distress. For example, theregular monitoring of pain in hospital settings is recommended to assess pain severity and reliefin all patients at risk for pain. 51, 52 Further, recommendations also suggest that clinicians shouldteach patients and families to use assessment tools in the home to promote continuity of painmanagement in all settings.The principles involved in routine pain assessment may be usefully applied for other symptoms.It is likely that the measurement of symptoms:• Can improve patient outcomes by increasing staff awareness of symptoms,distress and the response of symptoms to treatment interventions• Has the potential to increase patient attention to reporting distress60U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau