Health Psychology

Health Psychology Chapter 11 Living with Chronic Illness Tuğba Yılmaz 2009-2010 Fall Semester

Topics • Dealing with HIV and AIDS • Living with Alzheimer’s Disease • An interview with a case example

1. Dealing with HIV and AIDS

AIDS - Acquired Immune Deficiency Syndrome EBES- Edinilmiş Bağışıklık Eksikliği sendromu • A disorder in which immune system (I.S) loses its effectiveness, leaving the body defenseless againts invaders • Result of exposure to HIV (Human Immunodeficiency Virus) which is a contagious virus • Two variants: HIV-1 nd HIV-2 • HIV-1: AIDS cases in US • HIV-2: AIDS cases in Africa

Incidence and mortality for HIV and AIDS • Recognized in 1981- identified in 1983 • 1980s - # of new cases and deaths from AIDS • Mid 1990s death rates in US • 2001- ~ 40 million infected people • 1992 definition of HIV altered – graphs are not comparable but after 1992, AIDS cases decline • Greatest mortality decline b/w 1996 and 1998. • Reasons: • HIV infected people live longer • Effective drug therapies – antiretroviral drugs • Early detection • Lifestyle changes- giving up unhelthy habits

HIV and AIDS Epidemics Declined during 1990s but still leading cause in USA • 4 distinct epidemics in US and Europe. They are about different ways of AIDS transmission • First epidemic • Male-male sexual contact- many AIDS cases in USA • Heterosexual sex- many AIDS cases in Africa and Asia • Second epidemic • Injection drug users Percent of cases remain the same

Number is increasing! Women more likely to be infected thru this route • Third epidemic • Heterosexual contact • Fourth epidemic • From women to their children during delivery process In USA and Europe; M>W in terms of HIV infection W thru heterosexual contact or injection of drug use Worldwide W - 46% of AIDS cases and half of deaths majority in sub-Saharan Africa Decreased sharply due to antiretroviral medication

Factors related with AIDS 1. Ethnic Background In USA affected disproportionately by epidemics for heterosexuals epidemics for injection drug users From largest segment of AIDS population to smallest African American>European American>Hispanic American>Asian Americans Declining rates of HIV trend X apply rapidly for minorities as it does for European Americans 2. Age Birth process transmission (4th epidemic)- children HIV + Young adults are most risky group risky behaviors, lack of HIV info, lack power for protection gender and ethnicity- most are M and belong to ethnic minorities People over 50 – less likely to be infected than youngers but if they did, develop AIDS more rapidly and get more infections

Symptoms of HIV and AIDS Fourth stage: CD4+ T-lymphocyte cell count drops to 200/ less per cubis millimeter of blood. I.S. Loses its defensive capacity. Symptoms are exacerbated. I.S. More susceptible to invaders- viruses, bacteria, fungi etc. HIV progresses over a decade or more thru 4 stages; Third stage: patients have a group of symptoms like swollen lymph nodes, fever, fatigue,loss of appetite and weight and diarrhea Second stage: it is a latent period lasts as long as 10 years. People seem asymptomatic end experience mild symptoms First stage: symptoms are not easily distinguisable from other diseases. Examples: sore throat, fever, skin rash and headache. Duration is b/w 1 and 8 weeks

The transmission of HIV • HIV is an infectious organism but transmission of the virus from person to person is not easy. • Main routes of transmission are sex, pregnancy/birth and direct contact w/ blood or blood products. • Concentrations of HIV are esp. high in semen and blood • Contact w/ saliva, urine, tears is less risky • Using same utensils, cups of infected people, kissing and touching X transmit HIV • People at high risk for HIV are those affected by four epidemics 1. male-male sexual contact, 2. injection drug use, 3.heterosexual contact, 4. from mother to baby

1. Male- Male Sexual Contact • Early years- majority of AID cases; Now- HIV infection among gay and bisexual men • Still the largest risk group • Damaged rectum is a route for virus to enter body • Receptive partner is at high risk • Remember : Semen has high concentration of HIV virus • Condom use is essential for protection • Common in old gay men but not in younger ones • Risk taking- unprotected sex is risky

2. Injection Drug Use • Sharing unsterilized needles • Second most frequent source of HIV infection in USA • Causes: Intoxication and Lacking immediate access to sterile equipment • Great percentage of African & Hispanic Americans > European Americans • Higher percentage of infected women • Behavioral factors: • # of sex partners • Sex for $ or drugs • Financially dependent women on men are at risk • X refuse sex w/ infected partner

3. Heterosexual Contact • - Leading source of HIV infection in Africa • Fastest growing source in USA • African & Hispanic Americans disproportionately represented and W>M • Gender asymmetry: male to female = 8 x female to male transmission • An Interesting result: • Trust and confidence of one’s partner in heterosexual relationship is not a good predictor about who will become infected w/ HIV or not. • Unprotected sex is due to belief that one is invulnerable to serious diseases

4. Birth Process • Children born to HIV positive women • Transmission during birth process or breast feeding • HIV + children: • HIV + women still get pregnant; 15-30 % of their children are infected • Percentage could be lowered to 8 % by prenatal care

Our role… • Combating the spread on infection • Primary prevention: change in behavior to decrease HIV transmission • Secondary prevention: helping HIV + people to live with the infection, counseling and help dealing w/ social aspects of disease • Contribute to length of survival of HIV infected people

1. Encouraging protective measures • Most people have control in protection from HIV virus • Causal contact w/ infected people has low risk • Changing high risk behaviors: • Limiting # of sex partners • Using condoms • Avoiding sharing needles • Health care workers- special protective equipment- gloves, mask etc. • Don’t base judgments on appearance- HIV infection has long incubation w/out symptoms

2. Helping people w/ HIV Infection • Testing for HIV is difficult decision • Benefits: learn serostatus; if +, begin treatment to prolong their life, reduce behaviors that put others at risk • Costs: increased anx, depr, anger, distress • Coping: • Avoidance coping- deny reality and hold on to illusionary hope- high level of stress, low levels of CD4 cells • Active coping- problem solving & seeking support- better adjustment • Finding meaning and positive experience IMP • Help with adherence to complex regimens: min. three different antiretroviral drugs, drugs for side effects for antiretroviral drugs drugs to fight for opportunistic infections A dozen drugs

2. Living with Alzheimer’s Disease • An interview with a case example

Alzheimer’s Disease • A degenerative disease of the brain • Major source of impairment among older people • Half of people over 85 affected • Better diagnosed with autopsy • Early onset vs Late onset • EO: before 60 age- rare- 1%- genetic defect • LO: after 65 age- apolipoprotein e (cholesterol metabolism) can occur w/out family history

Genetic and environmental/experiential factors interact: • Type 2 diabetes • Mild brain trauma • Aluminum concentrations in drinking water • Protective Factors: • Low levels of alcohol consumption • Nonsterodial anti-inflammatory drugs • Folic acid • Cognitive activity 

Age is the biggest risk factor; disease sharply w/ age • Symptoms are similar to psychiatric disorders, so it is difficult to diagnose • memory loss • language problems, • agitation and irritability • sleep disorders, • suspiciousness and paranoia • incontinence • sexual disorders • Distress for the patients and their caregivers • Most common psychiatric problem is depression and depressed mood- Esp. Common in EO

Symptoms of Alzheimer patients

Memory loss Characteristic of Alzheimer’s First appear as small ordinary failures of memory e.g. “Şey” Progress into failure to recognize family members At early phases, patient is aware of the problem and feel distressed Agitation, irritability Even violence symptoms appear Outbursts of anger are possible • Paranoia and suspiciousness Related with cognitive impairments Forget where they put belongings, accuse others of taking them

Sleep problems Difficulty staying asleep- more severe than peers Wander at all times of the day and night Opportunity to injure themselves • Incontinence Stressing for patients and caregivers Incontinence common in advanced cases

Helping the patient • Alzheimer’s is treatable but not curable • Drugs to delay the progression of cognitive deficits, reduce agitation, • Music • Pets • Behavioral approaches • Alterations in environment • Changes in patient behaviors • Taking notes For relaxation

An interview with a case example

Helping the family • Symptoms of the illnes are particularly distressing to the families • Memory impairments- fail to recognize members • Cognitive impairment- changes in personality • Suspiciousness and accusations hurt • Violent acts upset family functioning

Caregivers • In USA- mostly women: wives or daughters • Men receive more help than wome in care giving • Caregivers experience stress and strain exhibit symptoms: • Fatigue • Frustration • Helplessness • Grief • Shame • Embarrassment • Anger • Depression

Caregivers • Interest of PNIs: effect of chronic stress on I.S. • The more impaired the patient, the more stressed the caregiver • CBT help caregivers to manage negative emotions • Support groups- sharing feelings, getting info about caring • Caregivers experience feelings of loss for the relationship that they once shared w/ the patient ~ bereavement

Health Psychology