BY: SHAREEN BOOMGAARD PROFESSIONAL NURSE LUTHANDO CLINIC CHRIS
HANI BARAGWANATH HOSPITAL BASIC MENTAL HEALTH ASSESSMENT
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MENTAL ILLNESS & HIV Because HIV affects the brain It has
effects on mental health MOOD EMOTIONS THINKING BEHAVIOUR Can all
be affected!
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MENTAL ILLNESS IN HIV Mental illness is more common in HIV The
mentally ill are more likely to contract HIV due to the nature of
their illness These patients have stressors e.g. money,
relationships, stigma The direct effect of HIV on the brain
Medication they take for HIV or TB have mental side-effects They
are more likely to engage in risky sexual behaviours Substance
Abuse Their ability to make good decisions and choices are
affected!
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MENTAL ILLNESS IN HIV STIGMA is a negative/bad thought that you
or others may have about you These patients have to deal with a
DOUBLE STIGMA HIV and mental illness - This may hinder access to
HIV clinics for HAART - This may result in poor adherence, hence
viral resistance This is why it is important to be able to identify
patients with mental disorders so that they can be referred for
help.
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CONFIDENTIALITY When you enquire about someones mental health
you need to at all times take into consideration the importance of
confidentiality. You are in a unique position to receive personal
and private information about the patient. You need to respect this
by not sharing it with anyone except another health professional so
that their condition can be managed properly
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IN GENERAL People working with HIV + patients need to be aware
that these patients can present with psychiatric/mental illness. In
your everyday encounters with people we usually make assessments
automatically How is he/she dressed? Is he/she clean and looking
after themselves Does the person look worried or sad ? Agitated?
Nervous Suspicious? Aggressive ?
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BAD MOOD vs ILLNESS It is usual for any particular person to
have changes in mood, within one day, and every few days depending
on the events, happenings, stressors, etc at the time. NORMAL
BIRTHDAYPAYDAYHOLIDAY NORMAL MONDAYARGUMENT
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MOOD DISORDERS DEPRESSION - With a depressive disorder the mood
stays low for many days weeks. - It is worse than usual and affects
the patients ability to carry out their daily activities normally.
You need to ask how the patient has been feeling lately, and also
notice whether or not the persons body language seems to match what
he/she is saying.
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DEPRESSION SYMPTOMS OF DEPRESSION - Sadness - Loss of
interest/pleasure - Disturbed sleep - Disturbed appetite/ change in
weight - Poor concentration - Tiredness - Guilty feelings -
Suicidal thoughts
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When to refer? When symptoms are severe Eg: not eating/drinking
at all or suicidal Since depression symptoms are similar to the
physical symptoms of HIV eg loss of weight, tiredness The
differentiation between the two needs to be made. If unsure refer
for an assessment
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THE SUICIDAL PATIENT - There are times in an HIV + patients
life when they feel like they have no hope left to live Eg: when
they find out about their HIV status. when their loved one dies
from HIV when their CD 4 count drops when they are diagnosed with
TB or cancer ASK THE PATIENT: How do you feel? Do you feel that
life is not worth living? Do you have thoughts of wanting to kill
yourself? Do you have a plan to kill yourself? When someone is
suspected of being suicidal, it is ALWAYS NECESSARY to refer them
to a mental health nurse or doctor.
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THOUGHTS Getting to know what the patient spends time thinking
about provides a window into the mind Negative thoughts may suggest
depression On the other hand Thoughts may be jumbled up or be about
things that cannot be true e.g.he is an alien. The patient may have
odd/unusual experiences eg. Hearing voices or they have been
speaking to themselves These would indicate that the person is
PSYCHOTIC = out of touch with reality
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COGNITION This is our ability to think, remember, understand
and organize information. Patients living with HIV/AIDS are at risk
of developing problems with these functions This is called HIV
Dementia They usually struggle with everyday activities, like
cooking, cleaning, or taking medication
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HIV DEMENTIA It is useful to take note when the patient has
clear difficulties in paying attention, not being able to remember
questions or other facts, and has slow thinking ASK YOURSELF: Does
thinking seem slow? Is the person able to concentrate? Does the
memory seem impaired - Refer these patients for a specialized
assessment as HIV Dementia is a WHO stage IV condition and the
patient qualifies for HAART.
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SUBSTANCE ABUSE ALCOHOL When people are drunk, or under the
influence of drugs, they are more likely to take risks which put
them at risk of contracting HIV, or spreading it. When patients are
intoxicated they forget to take their ARVs and other important
medication and this prevents them from becoming well Substance
abuse can lead to anxiety, depression and psychosis.
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CONCLUSION If you identify mental health problems in a patient
referral to a clinic sister or doctor is the next step REMEMBER:
Patients are less likely to admit to having mental disturbances. We
need to make them feel comfortable enough to open up to us. We need
to have a non-judgemental attitude and gain their trust. This would
help us to get them the help they need.
