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Biomedical subjects

R H Remien

Publications and source records attributed to R H Remien.

32 records · Page 2Linked to original sources
PubMed1996

Personality disorders predict onset of Axis I disorders and impaired functioning among homosexual men with and at risk of HIV infection.

BACKGROUND: A longitudinal study was conducted to investigate whether personality disorders (PDs) increase risk for the development of future Axis I disorders and serious functional impairment among human immunodeficiency virus (HIV)-seropositive and HIV-seronegative homosexual men. METHOD: Baseline assessments of PDs, Axis I disorders and symptoms, and Global Assessments of Functioning were conducted with a community sample of 107 (66 HIV-positive and 41 HIV-negative) homosexual men participating in a longitudinal study with semiannual interviews over 3 years. RESULTS: Logistic regression analysis indicated that PDs predicted onset of subsequent Axis I disorders after controlling for both HIV status and lifetime Axis I history (adjusted odds ratio, 4.31; P=.01; 95% confidence interval, 1.39 to 13.32). Of the 21 participants with PDs, 16 (76%) were subsequently diagnosed with Axis I disorders on at least one occasion. By contrast, only 36 (42%) of the 86 participants without PDs were subsequently diagnosed with Axis I disorders. Further, 33% of the participants with PDs, in comparison with only 8% of those without PDs, were assigned Global Assessments of Functioning scores of 50 or lower, indicating serious impairment during the postbaseline study period (adjusted odds ratio, 5.70; P<.005; 95% confidence interval, 1.66 to 19.53). CONCLUSION: Personality disorders may contribute to increased risk for onset of Axis I disorders and serious impairment among homosexual men regardless of HIV serologic status.

Adult↗
PubMed1995

Intimacy and sexual risk behaviour in serodiscordant male couples.

Several studies have demonstrated individual-level determinants of HIV sexual risk behaviour. Very little research has been conducted to identify couple-level factors associated with unsafe sexual behaviour. As part of a three-year study of more than 100 serodiscordant male couples, we conducted an in-depth qualitative study of 15 Latino and non-Latino male couples via focus groups and a follow-up telephone survey. We identified the sexual risk behaviour that occurs in these male couples, their perceptions of susceptibility for HIV transmission, and numerous couple-level and intrapsychic factors associated with their risk behaviour. We also describe the challenges confronted by these couples and barriers to emotional intimacy and couple satisfaction. Finally, we provide suggestions for ways of intervening to facilitate improved couple functioning, pleasure, satisfaction, and communication, and ways of reducing sexual risk behaviour without loss of emotional intimacy.

Adaptation, Psychological↗
PubMed1995

Axis I psychiatric symptoms associated with HIV infection and personality disorder.

OBJECTIVE: The prevalences of personality disorders among HIV-positive and HIV-negative homosexual men were compared, and the presence of personality disorders was related to axis I psychiatric disorders, psychiatric distress, and impaired functioning. METHOD: The subjects were 162 homosexual men who either were HIV seronegative (N = 52) or were seropositive and had absent to moderate physical symptoms (N = 110). Lifetime and current histories of DSM-III-R axis I disorders, current diagnoses of DSM-III-R personality disorders, and levels of anxiety, depression, hopelessness, and adaptive functioning were assessed. RESULTS: In both the seropositive and seronegative groups, 19% of the study participants were diagnosed with personality disorders. The seropositive participants with personality disorders reported higher levels of psychiatric symptoms and poorer functioning than all participants without personality disorders, and they were over six times as likely as the seronegative participants without personality disorders to have current axis I disorders. CONCLUSIONS: These findings indicate that HIV infection and personality disorders may interactively increase the likelihood of clinically significant psychiatric symptoms.

Anxiety Disorders↗
PubMed1995

Remission of substance use disorders: gay men in the first decade of AIDS.

OBJECTIVE: Participants in a 5-year prospective study of HIV-seropositive and seronegative gay men demonstrated a significant decline in the rate (from lifetime to current) of alcohol and other DSM-III-R psychoactive substance use disorders. The goal of the current study was to identify factors associated with the cessation of problematic substance use, to observe rates of relapse over 4 years, and to describe factors associated with relapse and no relapse. METHOD: A volunteer community sample of self-identified gay men (N = 56) were administered a semi-structured interview and several self-report measures by trained mental health clinicians, twice annually over a 5-year period. RESULTS: Retrospective and prospective data revealed a significant decline in substance use and problems associated with use in the decade of the 1980s. This change occurred, for the most part, without formal treatment. Numerous motivating factors were associated with this change, which included a fear of AIDS, a change in attitudes in the gay community, changes in other risk-taking behaviours and concerns about self-image. A variety of informal methods were employed. Most notable was "avoiding situations associated with substance use." CONCLUSIONS: Changes in substance abuse/dependence occurred in the context of health concerns, caring for oneself and "cleaning up one's act." Having a concern about "self-image," avoiding situations associated with drug use and not using "drug substitution" as a method of quitting were important factors for maintaining successful change.

Adult↗
PubMed1994

Psychopathology in male and female intravenous drug users with and without HIV infection.

OBJECTIVE: The authors report on results of systematic clinical assessment of psychopathology among HIV-positive and HIV-negative intravenous drug users. METHOD: As part of a multidisciplinary baseline assessment, 147 male (85 HIV-positive and 62 HIV-negative) and 76 female (39 HIV-positive and 37 HIV-negative) intravenous drug users were evaluated with the Structural Clinical Interview for DSM-III-R and measures of psychiatric symptom severity, global functioning, and stress. RESULTS: Prevalence of a diagnosis of current depression (26%) and severity of depressive and anxiety symptoms in both HIV-positive and HIV-negative subjects were greater than in the general community, but not greater than in other studies of intravenous drug users. HIV-positive men had a higher prevalence of depressive disorders than HIV-negative men (33% and 16%, respectively), although this pattern was not found among women (26% and 30%). Diagnosis of depressive disorders and severity of depressive and anxiety symptoms were associated with a symptom-based measure of HIV illness stage, but not with indices of immune functioning (CD4+ cell count and CD4+ cell percent). CONCLUSIONS: Despite selective associations between HIV illness variables and depression, high rates of depression across HIV status in this cohort suggest that intravenous drug use and associated factors are more salient than HIV illness factors in understanding psychopathology in this population.

Anxiety Disorders↗
PubMed1992

Bereavement reactions among homosexual men experiencing multiple losses in the AIDS epidemic.

OBJECTIVE: The authors examined whether deaths of lovers and close friends from AIDS increased the frequency of depressive symptoms and depressive disorder in a group of homosexual men. METHOD: Two hundred seven volunteer male homosexual subjects were interviewed in New York City in 1988 and 1989. Depressive symptoms were measured with the Hamilton Rating Scale for Depression, administered by a clinician, and two self-report symptom checklists. Subjects were evaluated for major depression with the Structured Clinical Interview for DSM-III-R. Each subject also reported the number of lovers and close friends who had died of AIDS 1) since the beginning of the epidemic in 1981 and 2) in the 6 months preceding the interview. RESULTS: Neither the overall level of depressive symptoms, the presence of specific symptom clusters, nor the presence of a diagnosed depressive disorder was related to the number of AIDS deaths a subject reported in either time frame. In contrast, bereavement reactions specific to loss, namely, preoccupation with and searching for the deceased, were more common in subjects with greater numbers of losses. The findings for depressive symptoms and major depression are not readily explained by measurement artifact, overrepresentation of asymptomatic subjects among study volunteers, habituation effects, numbness, or shallowness of attachments in the subjects. CONCLUSIONS: Changes in normative expectations regarding AIDS deaths and mobilization against AIDS within the gay community may account for the lack of association between the number of losses resulting from AIDS and the presence of depressive symptoms and depressive disorder.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Dementia after stroke: baseline frequency, risks, and clinical features in a hospitalized cohort.

We determined the frequency of dementia in a cohort of 251 patients aged greater than or equal to 60 years hospitalized with acute ischemic stroke, based on examinations performed 3 months after stroke onset. Using modified DSM-III-R criteria, we found dementia in 66 patients (26.3%). Diagnostic agreement among raters was excellent (kappa = 0.96). In a control sample of 249 stroke-free subjects recruited from the community and matched by age, we found dementia in eight subjects (3.2%). Using a logistic regression model to estimate the risk of dementia associated with stroke in the combined samples, the odds ratio (OR) for stroke patients compared with control subjects was 9.4 (p less than 0.001). Advancing age and fewer years of education were significant, independent correlates of dementia, with a trend evident for race (non-white versus white). Confining the analysis to subjects residing in the Washington Heights-Inwood community of northern Manhattan, the OR was 10.3 (p less than 0.001) with significant age and race effects. We conclude that ischemic stroke significantly increases the risk of dementia, with independent contributions by age, education, and race.

Aged↗
PubMed1991

Depression, distress, lymphocyte subsets, and human immunodeficiency virus symptoms on two occasions in HIV-positive homosexual men.

We evaluated the extent to which depressive disorders, psychiatric distress, and psychosocial stressors are related to three measures of human immunodeficiency virus (HIV) illness, both cross-sectionally and during a 6-month period, in a community sample of 124 HIV-positive homosexual men. The dependent variables are immune status measured by CD4 and CD8 cell subsets, number of signs and symptoms commonly associated with HIV infection, and a cumulative index of HIV illness stage. We chose to focus on CD4 cell count because it is the immune marker most closely linked to the clinical consequences of HIV infection. We found no relationships between the independent variables and immune status or illness stage. The HIV-positive men who were depressed or distressed or who reported more life stressors had no greater immunosuppression or more advanced illness stage than did the others, either concurrently or across occasions. We did find a suggestive pattern of association between depressive disorders, distress, and stressors and the number of HIV-related symptoms, which warrants further study.

Adult↗
PubMed1991

Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection. II. Standardized clinical assessment of current and lifetime psychopathology.

Despite numerous reports of the psychiatric consequences of human immunodeficiency virus infection, few reports describe systematic diagnostic assessments of people with human immunodeficiency virus infection. We studied the results of standardized clinical assessments of current and lifetime psychopathology in a large group of homosexual men whose serologic status was known. Results indicated low rates of current mental disorders but very high rates of lifetime major depression and alcohol and other psychoactive substance abuse and dependence disorders. Measures of severity of psychopathology and functioning also indicated, on the whole, good current functioning. No significant relationship was found between stage of medical illness or immune status and any measure of psychiatric disturbance.

Adult↗
PubMed1990

Maintenance of hope in HIV-spectrum homosexual men.

The struggle to maintain hope has been described as a central theme faced by clinicians who work with HIV-spectrum people. The authors investigated psychiatric and psychosocial variables thought to be related to level of hope in a community sample of 208 HIV-positive and HIV-negative homosexual men, with the goal of identifying possible risk and protective factors in the progression of HIV infection. Overall, they found high levels of hope and low levels of current syndromal disorder or depressive symptoms. While the sample was a selected group of successful and well-educated homosexual men, it nevertheless remains noteworthy that they were able to preserve a sense of faith in their future despite HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Recurrent major depressive disorder among human immunodeficiency virus (HIV)-positive and HIV-negative intravenous drug users: findings of a 3-year longitudinal study.

A longitudinal study was conducted to investigate the association between human immunodeficiency virus (HIV) infection, history of major depressive disorder (MDD), and persistent or recurrent MDD among intravenous drug users. Psychiatric disorders were assessed in a sample of HIV-positive (HIV+) and HIV-negative (HIV-) intravenous drug users every 6 months for 3 years. Results indicated that HIV status and baseline MDD independently predicted persistent or recurrent episodes of MDD after gender, drug use, ethnicity, income, and the presence other psychiatric disorders were controlled statistically. Among HIV+ intravenous drug users with baseline MDD, 90% experienced at least one subsequent episode of MDD and 47% experienced at least three subsequent episodes of MDD. However, less than 40% of intravenous drug users with current MDD received treatment for emotional problems. These findings indicate that intravenous drug users with HIV infection and a history of MDD are at considerable risk for future episodes of MDD or recurrent MDD, and that increased provision of treatment for intravenous drug users with MDD may be necessary.

Adult↗