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Medical News

Symptoms of Depressed HIV Patients Not Just Psychological

August 7, 2002


This article is part of The Body PRO's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

A new study published in the July issue of Journal of General and Internal Medicine (2002;17;7) suggests that physicians could be making a lethal mistake if they do not give the same credibility and treatment to depressed HIV patients that they give to non-depressed HIV patients. A research team found that HIV patients who experience more symptoms -- regardless of how depressed they may or may not be -- are more likely to die within the coming year. Physicians tempted to dismiss symptoms reported by a depressed patient with HIV, the study indicated, are missing the bigger picture.

Lead author Dr. Amy M. Kilbourne of the Veterans Administration Pittsburgh Center for Health Equity Research and Promotion explained that physicians have long been aware that depressed patients with HIV report more symptoms than non- depressed patients with HIV. "Yet clinicians are given little guidance as to what to do in response to symptoms reported by depressed patients," she noted. "Should clinicians first treat the depression and observe whether the symptom resolves, or should they also search for the medical causes of the symptom?"

Kilbourne and colleagues used data from a large-scale study of 881 HIV patients treated at Veterans Administration Medical Centers in Cleveland, Houston and Manhattan between June 1999 and July 2000. The investigators surveyed patients' medical records to determine the severity of their illness, the nature and number of their HIV symptoms, and how bothersome those symptoms were. The researchers simultaneously assessed each participant's level of depression. The team followed the patients' medical progress during the following year.

At the one-year mark, the authors found, those patients who had begun the study with the highest number of HIV disease symptoms were more likely to be among the 53 participants who died. Because severe depression and serious symptoms often go hand in hand, many of those who died had been severely depressed when first interviewed. However, analysis revealed that the severity of a patient's symptoms -- regardless of level of depression -- was the strongest predictor of whether that person would live or die in the coming year.

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"In a prior survey of over 200 primary care providers... providers were less likely to believe that a patient with a prior psychiatric history who presented a new symptom had a potentially serious physical illness. This is perhaps due to the provider's perception that patients with depression exaggerate their physical symptoms," Kilbourne wrote. Although Kilbourne by no means advised ignoring psychological distress, she did warn against treating the medical symptoms of HIV any differently in depressed and non-depressed patients.

Back to other CDC news for August 7, 2002

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Adapted from:
Pain & Central Nervous System Week
07.29.02




This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
 

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