Fall 1993
Diagnosing AIDS Dementia Complex
Accurate diagnosis and treatment of neuropsy-chiatric problems can make a dramatic difference in quality of life for people with HIV and AIDS. Clinicians can often spot the early signs of major depression and AIDS dementia complex (ADC) by observing patients and asking specific questions. They can then refer patients for further evaluation or prescribe treatment.
"Sadness is normal in people with AIDS, but major depression is not,"says Jonathan Worth, director of the Robert B. Andrews Unit at Massachusetts General Hospital. "It is important to keep in mind that we have very effective treatments for major depression."
Signs of major depression include pervasive sad moods, sleep disorders, concentration problems, suicidal thoughts, appetite loss, and disinterest in things that once gave pleasure. Individuals with these symptoms should be referred for more in-depth neurologic and psychiatric evaluation. Research has shown that a number of treatments are effective, ranging from antidepressants to psychotherapy. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM IIIR) lists detailed criteria for evaluating clinical depression.
Like major depression, ADC -- also called HIV encephalopathy and neurocognitive syndrome -- can be difficult to diagnose. Researchers believe, however, that if ADC is diagnosed early, antiretroviral therapy such as AZT can abate its devastating effects. Early signs of ADC include short-term memory impairment, concentration and comprehension problems, withdrawal, apathy, coordination problems, muscular weakness, and depression.
Addressing other aspects of an individual's life -- such as the social isolation often associated with AIDS, drug use, and homelessness -- requires collaboration between many disciplines. Time invested in these issues, however, can dramatically improve quality of life for individuals with HIV and AIDS.
"AIDS is not just a medical illness; it affects every facet of a person's life,"says Marshall Forstein, director of HIV mental health services at The Cambridge Hospital. "Although we have more hope because people are not dying as quickly, we need to be more aggressive with mental health interventions." |
