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Biomedical subjects

B Fishman

Publications and source records attributed to B Fishman.

At least 19 recordsLinked to original sources
PubMed2004

Predictors of attrition in HIV-positive subjects with peripheral neuropathic pain.

The objective of this paper was to identify predictors of attrition in a study designed to assess whether cognitive behavioural therapy (CBT) was more helpful than supportive therapy (SP) in reducing pain associated with peripheral neuropathy in HIV-positive patients. Sixty-one subjects were randomized into either CBT or SP for six weekly one-hour sessions. Twenty-eight subjects dropped out before week six. Demographic variables such as age, gender, ethnicity, socioeconomic status and level of education were not predictive of attrition. However, higher scores on the Hamilton Depression Inventory (HAM-D, 17-item) (t (59) = - 0.09, p<0.05) were predictive. These findings suggest that while dropouts were not more physically ill (e.g. CD4 counts, viral loads and opportunistic infections were not statistically higher), they reported greater psychological distress.

Cognitive Behavioral Therapy↗
PubMed2000

Health locus of control, distress, and utilization of protease inhibitors among HIV-positive men.

OBJECTIVE: To investigate the relationship between health locus of control (HLOC), distress, and protease inhibitor (PI) utilization in gay/bisexual men in all stages of HIV illness. METHOD: A total of 173 men participating in a longitudinal study of the psychological effects of HIV illness were administered a number of psychological distress measures and the HLOC scale. The association between the HLOC subscales, distress, and PI utilization was evaluated. RESULTS: In addition to physical symptoms, the attribution of health status to chance or fate significantly predicted depressive symptoms, feelings of hopelessness, and recent life stress. Results also demonstrated a significant relationship between strong, positive beliefs in doctors and other health care professionals and PI utilization. CONCLUSION: The results of this study point to a strong association between beliefs that health status is related to chance or fate and distress. In addition, beliefs in physicians and other health care providers appear to contribute to decisions to initiate PI therapy.

Adult↗
PubMed2000

Plans to hasten death among gay men with HIV/AIDS: relationship to psychological adjustment.

This study assessed the prevalence and nature of thoughts and future plans to end one's life in a group of gay men with HIV/AIDS over an 18-month period. HIV-positive men (n = 167) participated in a series of clinical interviews which measured current health status, current and past psychiatric disorders, current levels of distress, and thoughts and plans about ending their lives currently or at some future point. A small number of HIV-positive men (17%) reported serious thoughts or plans to end their lives at some point in the future which were stable over an 18-month period. No differences in psychiatric or medical measures were observed among men with and without thoughts/plans at either assessment point. In the absence of current psychiatric disorders, such thoughts or plans about the future may represent one way to maintain control and independence in the face of the uncertainty of life with HIV illness.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Role of health communications in Russia's diphtheria immunization program.

As part of a broader program in health communication assistance, project staff from Basic Support for Institutionalizing Child Survival worked with staff from Russia's oblast (regional) public health agencies to design and implement communication activities supporting local diphtheria immunization efforts. Because aggressive community outreach efforts and strong administrative sanctions had already achieved impressive adult coverage rates for first doses of diphtheria toxoid vaccine, communication interventions emphasized the need for second and third doses. Outcomes were assessed through vaccination coverage data and more qualitative measures. In one project site, the increase in adult coverage (two or more doses) was very modest. In a second site, with a stronger communications component, coverage increased significantly (from 20% to 80%). Although it is not possible to disentangle completely the effects of communications from other aspects of oblast immunization programs, these and other outcome data suggest that health communications can play an important role in Russia's ongoing mass immunization efforts.

Adult↗
PubMed2000

An exploratory study of ethnicity and psychotherapy outcome among HIV-positive patients with depressive symptoms.

Few data address the relationship between ethnic status and psychotherapy outcome. This study reports data from a four-cell, 16-week controlled clinical trial for HIV-positive patients with depressive symptoms. Patients (N = 101) were randomized to 16 weeks of treatment with interpersonal psychotherapy, cognitive-behavioral therapy (CBT), supportive psychotherapy, or imipramine plus supportive psychotherapy. Analyses found an ethnicity-by-treatment interaction wherein African-American subjects (n = 18) assigned to CBT (n = 4) had significantly poorer outcomes than other patients. This is the first study to uncover an ethnicity-by-specific psychotherapy interaction. Its meaning is unclear. This charged topic requires cautious treatment, particularly given the small sample size in this study, but warrants further research.

Depression↗
PubMed1998

Treatment of depressive symptoms in human immunodeficiency virus-positive patients.

BACKGROUND: This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms. METHODS: Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIV-positive patients. Treatment adherence was monitored. RESULTS: Subjects randomized to interpersonal psychotherapy (n = 24) and supportive psychotherapy with imipramine (n = 26) had significantly greater improvement on depressive measures than those receiving supportive psychotherapy (n = 24) or cognitive behavioral therapy (n = 27). Similar results appeared in the completer subsample. CONCLUSIONS: Depressive symptoms appear treatable in HIV-positive patients. Interpersonal psychotherapy may have particular advantages as a psychotherapy for patients who have experienced the significant life events of HIV infection.

Adult↗
PubMed1998

Substance use disorders in gay/bisexual men with HIV and AIDS.

The authors conducted a longitudinal study of psychological adaptation to AIDS in subjects with and without lifetime and current substance use disorders (SUD), in a cohort of HIV+ gay/bisexual subjects. A sample of HIV+ gay/bisexual men (n = 183) and an HIV- comparison group (n = 84) were assessed for SUD, depression, and anxiety disorders. Among HIV+ men, combined lifetime (42%) but not current (11.5%) SUDs were more prevalent than in HIV- men (27% and 10%, respectively). HIV+ men with current SUD reported more depression, distress and diminished quality of life than HIV+ men with no SUD, but HIV-illness severity did not differ. HIV+ men in recovery did not differ from men with no lifetime history. Most HIV+ gay/bisexual men with SUD discontinue or reduce substance use before or subsequent to knowledge of their HIV infection, probably in an attempt to adopt a healthier lifestyle. However, for some HIV+ men, persistent substance abuse/dependence is accompanied by higher levels of distress and diminished quality of life, underscoring their need for treatment intervention.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The impact of multiple bereavement in a gay male sample.

The effect of experiencing multiple close losses on a variety of psychological symptoms was examined in a sample of HIV positive and HIV negative gay men over 1 year. Symptoms assessed included depression, intrusive and avoidant thoughts and images, anxiety, and general distress. It was found that on average, experiencing two or more losses in the year prior to the initial interview was associated with significantly higher levels of distress in follow-up assessment over 1 year. Comparisons between subjects with two or fewer losses versus three or more losses produced the largest differences in emotional symptoms. HIV positive subjects showed higher levels of distress symptoms on all measures, except for intrusive and avoidant thoughts and images. These findings indicate that the experience of multiple close losses, which is rather common among HIV-infected gay men, chronically exacerbates their emotional distress.

Adaptation, Psychological↗
PubMed1996

Distress reduction during the structured clinical interview for DSM-III-R.

In an attempt to assess the influence of standardized diagnostic interviews on psychological distress in research volunteers, the Visual Analogue Scale (VAS) was used to measure anxiety and depression during the Structured Clinical Interview for DSM-III-R, Non-patient version (SCID). Subjects were 50 adults with concerns related to the human immunodeficiency virus who were seeking testing and treatment in research trials. Repeated measures analysis of variance showed significant decreases in distress by the end of the interview: 72% of subjects reported diminished anxiety, and 54% reported diminished depression. Thus, the SCID appeared to provide a positive interview experience, a finding that may serve to reassure subjects, their families, and review boards regarding participation in studies that employ structured interviews.

Adult↗
PubMed1996

Development and validation of a patient needs assessment tool (PNAT) for oncology clinicians.

The Patient Needs Assessment Tool (PNAT) is an interviewer-rated scale that may be completed through a simple structured interview and screens cancer patients for potential problems in physical and psychosocial functioning. The instrument provides separate scores for physical, psychological, and social status, and can potentially clarify the types of interventions needed to address specific areas of dysfunction. Reliability and validity was tested in two studies that used prescreened patient videotapes and other materials to assess the performance of the PNAT in groups of oncology nurses, physicians, and social workers. The data demonstrate that subscale scores for the physical, psychological, and social dimensions have good inter-rater reliability and internal consistency (intraclass correlation coefficients of 0.71-0.97). Criterion and construct validity was suggested through high correlations of each subscale with the evaluation of expert raters (correlation coefficients of 0.85-0.95) and with scores on validated patient-rated instruments appropriate to the functional area. These analyses suggest that the PNAT is a valid scale for the assessment of a range of functional disturbances in the cancer population.

Activities of Daily Living↗
PubMed1995

Individual psychotherapies for depressed HIV-positive patients.

OBJECTIVE: The authors present preliminary data from two treatment modalities of a randomized clinical trial in which they compared 16-week interventions of interpersonal psychotherapy to supportive psychotherapy. METHOD: HIV-positive patients who were not acutely medically ill and had scores of 15 or higher on the Hamilton Depression Rating Scale were randomly assigned to one of four treatment modalities. They were assessed by the Hamilton scale and Beck Depression Inventory at 8 and 16 weeks. Most subjects who underwent either interpersonal psychotherapy (N = 16) or supportive psychotherapy (N = 16) were male, gay or bisexual, white, and college educated. RESULTS: Results of last-observation-carried-forward and completer analyses showed that scores on the Hamilton scale and Beck Depression Inventory decreased significantly for both treatments. Differential improvement for interpersonal psychotherapy appeared by midtreatment (week 8) and persisted at termination. CONCLUSIONS: This is the first controlled study of individual psychotherapies for depressed HIV-positive patients. Results suggest that a specific antidepressant psychotherapy, interpersonal psychotherapy, has advantages over a supportive therapy.

Depressive Disorder↗
PubMed1994

Self-disclosure of HIV infection to sexual partners after repeated counseling.

This study, with the objective of examining voluntary self-disclosure of HIV infection after repeated counseling, was conducted in a private setting, and designed to operate in conjunction with HIV testing. Counseling was provided at entry, and then at 3 months, 6 months, and every six months thereafter. The study was conducted among 129 HIV-positive adults; the primary risk factor was history of: males having sex with males (n = 104); injection drug use (n = 19); or heterosexual contact (n = 6). Results showed that after a mean of 2.3 years since initial HIV-positive notification, 29 percent of subjects had not disclosed the HIV infection to any present partner, and 30 percent to any past sex partner. Casual sex and lower perceived social support were significantly associated with nondisclosure. The authors conclude that even after repeated individual counseling and at least several months to inform others, about one-third of the sexually active subjects did not disclose their HIV infection to any present sex partner. Clinical and public health implications are covered.

Adolescent↗
PubMed1993

Severity of psychiatric symptoms after HIV testing.

OBJECTIVE: The authors were interested in the psychiatric effects of serological testing for HIV and what information feasibly available at intake might predict more severe psychiatric symptoms 1 year later. METHOD: HIV testing in a private office setting was offered to adults at perceived risk for HIV infection but without AIDS. At entry, then 6 and 12 months later, subjects were counseled by psychiatric nurses and assessed by the Hamilton Rating Scale for Depression, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Brief Symptom Inventory. RESULTS: Mean scores on all measures of psychiatric symptoms were lower at follow-up among both 106 HIV-positive and 222 HIV-negative adults. One year after HIV testing, 121 (37%) of the 328 subjects had scores associated with psychopathology. These elevated scores were not predicted by serostatus but by initial psychopathological scores (N = 150), annual income less than +15,000 (N = 114), being female (N = 46), and history of injection drug use (N = 32) and heterosexual risk factors (N = 60) as compared to males having sex with males (N = 236). CONCLUSIONS: Before the development of more severe physical symptoms, on average, knowledge of HIV infection does not increase psychiatric morbidity; however, regardless of serostatus, a notable percentage of at-risk adults have sustained high levels of psychiatric symptoms. Counseling during the HIV testing process provides an opportunity to identify these individuals for closer study and indicated psychiatric treatment.

AIDS Serodiagnosis↗
PubMed1993

Self-disclosure of HIV infection to dentists and physicians.

We prospectively examined self-disclosure of HIV infection by 129 men and women to dentists and physicians. After an average of 2.3 years since initial HIV-positive notification and repeated individual counseling, only 53 percent of subjects had told their dentists of HIV infection compared to 89 percent who had told their physicians. This high rate of non-disclosure despite extensive counseling raises concern about effectiveness of education alone in promoting voluntary self-disclosure. Our findings further support recommended universal precautions.

Adolescent↗
PubMed1992

Relationships over 1 year between lymphocyte subsets and psychosocial variables among adults with infection by human immunodeficiency virus.

To examine relationships between immune and psychosocial variables among adults infected with human immunodeficiency virus type 1, 221 subjects without acquired immunodeficiency syndrome were assessed for degree of depression, anxiety, psychiatric symptoms, social support, stressful life events, hardiness, hopelessness, bereavement, and intrusive and avoidant thoughts about acquired immunodeficiency syndrome. At entry, none of 22 psychosocial variables significantly correlated with lymphocyte subsets. Among subjects seen 6 and 12 months later, severity of physical symptoms was associated with greater emotional distress, but the CD4 cell count was predicted by neither clinical ratings of psychopathology and global functioning nor by standardized self-report measures of constructs used in psychoimmune research. We conclude that among our sample, physical symptoms contributed to emotional distress, but emotional distress did not contribute to the CD4 cell count, a marker of disease progression.

Adolescent↗