No abstract

Delirium commonly occurs during myeloablative hematopoietic stem cell transplantation (HCT). Little is known about how delirium during the acute phase of HCT affects long-term distress, health related quality of life (HRQOL), and neurocognitive functioning. This prospective, cohort study examines these outcomes at 6 months and 1 year in 90 patients undergoing HCT. Patients completed a battery assessing distress, HRQOL, and subjective neuropsychological functioning before receiving their first HCT as well as at 6 months and 1 year. Patients with a delirium episode within the 4 weeks after HCT had significantly more distress and fatigue at 6 months (P<.004) and at 1 year (P<.03), compared with patients without delirium. At one year, patients with delirium also had worse symptoms of depression and post traumatic stress (P<.03). Patients with delirium had worse physical health on the SF-12 at 6 months (P<.03) and worse mental health on the SF-12 at 1 year (P<.03). At both 6 months and 1 year, patients with delirium after HCT reported worse memory (P<.009) and executive functioning (P<.006). Delirium during the acute phase of HCT is significantly associated with persistent distress, decreased HRQOL and subjective neurocognitive dysfunction at both 6 months and 1 year.

Late-onset, recurrent depression takes longer to respond to treatment than late-onset single-episode depression and is more strongly associated with cognitive and functional impairment. Further study of biological, neuropsychologic, and psychosocial correlates of late-onset, recurrent depression is needed.

This review outlines research since 2006 addressing psychiatric illness and/or co-occurring psychiatric illness and substance abuse as it relates to HAART access and adherence. Highlighted here are effective or promising interventions, or models of care, designed to enhance adherence among HIV-infected individuals with mental illness. Overall, we found that recent studies reinforce earlier findings that co-occurring substance abuse and psychiatric illness are associated with HAART nonadherence. Studies of depression/anxiety disorders among HIV patients reviewed here show that while depression is related to poorer medication adherence, treatment for depression can lead to increased HAART adherence. New studies also suggest that HIV patients with psychiatric diagnoses can effectively maintain HAART adherence with close monitoring by providers. While there are still very few adherence interventions among HIV patients with co-occurring mental illness and substance abuse, promising interventions include cognitive behavioral therapy and integration of mental health services with HIV primary care.