Treatment of Mood Disorder due to HIV/AIDS

                                                                                                                                                                                                                                                                            Kris Trairatana

Treatment Goals and Interventions of

Mood Disorder due to HIV/AIDS

 The clients with HIV/AIDS has contacted disease through many reasons; unprotected sexual activities with multiple partners, men having sex with men (MSM), sharing injecting drug users (IUDs) including a needle and syringe, a baby of an infected mother during pregnancy, delivery, or through breastfeeding, and blood transfusion or organ transplant (very rare). The mental diagnosis of prevalence is Mood Disorder due to a general medical condition (DSM IV-TR, 293.83, 2000).

 
In DSM TR (2000), the Criteria for 293.83-Mood Disorder due to a general medical condition are:
Criterion A: A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
(1)   Depressed mood or markedly diminished interest or pleasure in all or almost all activities.
(2)   Elevated, expansive, or irritable mood
Criterion B: There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

Criterion C: The disturbance is not better accounted for by another mental disorder (e.g. Adjustment disorder with depressed mood in response to the psychological stress of having a general medical condition)

Criterion D: The disturbance does not occur exclusively during the course of the delirium.

Criterion E: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Type of Mood Disorder: with depressive features

Short term treatment goals and interventions
1. The clients will experience a complete physical assessment and treatment regimen. The clients need to understand the medical condition and start treatment immediately to maintain and continue maximum of the quality of life. 

2. The clients will establish a trust and therapeutic rapport with the health care providers/counselors. The health care providers/counselor will be:

i)        Applying the client-centered principles (Carl Rogers’ theory) of unconditional positive regard, empathy and genuineness to build the trust and disclose the experience.

ii)      Utilizing distractive techniques, for example, using the “Talking, Feeling, and Doing Game” to build the therapeutic rapport.

3. The clients are well understanding or acceptance of disease and the consequence of the diagnosis.

i)        Confronting the denial through the use of disclosure technique of story/experience telling, when and how the clients verbalize their fears and anxieties.

ii)      Providing the clients participate in continual sustained writing or expressing concerning their feelings and worries.

iii)    Providing the clients attend a HIV/AIDS support group.

4. The health care providers/counselors demonstrate the accountability and responsibility by helping the client understand consistently taking medications at prescribed intervals and dosages including:

i)        Explaining the importance of taking medications and their medical conditions

ii)      Providing compliance with the follow-up visits to the doctors.

5. The health care providers/counselors need to recognize and explain the high risk behaviors related to with the disease.

i)        Encouraging the clients to notify all sexual partners have to be tested.

ii)      Providing the clients about current information, research, and document of the disease, including precaution, transmitted method, and HIV/AIDS situation. 

6. The health care providers/counselors need to identify any fears that are associated with the medical treatment and conditions

i)        Providing the clients keep a detailed list questions that they could ask the health care providers/counselors.

ii)      Providing the clients with any medication information that will clarify their questions that they may have.

7. The health care providers/counselors need to identify the emotional effects of the disease.

i)        Providing or suggesting the client participate the art therapy to draw and express about their feelings
ii)      Providing counseling section to explore their expression of angriness or grief by verbalizing communication, writing letters, or any strategies to release their feelings.

8. The health care providers/counselors need to discover other causes of stress that could be a reason of negative impact on their health status.

i)        Couching or teaching them how to use guided affect imagery (GAI), safe place technique, meditation, or relaxing techniques to release their stress.
ii)      Assigning the clients writes the journal or diary of activities and daily life including thoughts and feeling, which is precise to work within counseling section for their explanation.

9. The health care providers/counselors need to assist the clients to establish the healthier lifestyle for their quality of life.

i)        Acknowledging diet (nutrition) which is a factor for the clients. They could consult the nutritionist for the appropriate diet.
ii)      Encouraging the clients an exercise program to maintain and promote the body strength and firmness. They may need to consult a physical trainer to develop the physical fitness regime.

Long term treatment goals

1. The clients will understand the medical condition and treatment to maintain and continue maximum of the quality of life.

2. The clients will understand other acute medical conditions and symptoms which require emergency treatment.

3. The clients will have acceptance, which is a chronic and contiguous disease and required medical and personal care.

4. The clients will have well understanding of self care in medical condition and care, appropriate nutrition and exercise for the long term care period.

5. The clients will understand the prevention of increase of the disease, symptoms, complication, and prevention of the disease to others.

References
American Psychological Association (2000). Diagnostic and statistical manual of metnal distorders (Text Revision ed.). Washington, DC: Author.

Centers for Disease Control and Prevention (2004). Information concerning HIV/AIDS diagnosis and treatment. Retrieved on May, 2004 at http://www.cdc.gov/hiv/

Corey, Gerald. (2001). Theory and practice of counseling and psychotherapy (6th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.

Turner, Samuel M. & Hersen, Michel. (1997). Adult psychopathology and diagnosis (3rd ed.). New York, NY: John Wiley & Sons, Inc.