[Final Program, International Conference on AIDS (4th: 1988: Stockholm, Sweden), Book 2]

8569 NEUROPSYCPOLOGIC FUNCTIOTN IN FIV INFECTION:
STABLE AT 1.4-YEAR FOLLOW-UP
Andrew Saykin*, R Janssen**, C Sprehn*,
T Spira**, J Kaplan**, P Weller**, B O'Connor**,
M Gangarosa**
*Univ. of Pennsylvania, Philadelphia, PA, **Centers for
Disease Control, Atlanta, CA, USA
Objective. To characterize the natural history of
neuropsychologic function in FIV infection.
Methods. Twenty FIV-seropositive homosexual men
(patients) enrolled in a study of lymphadenopathy
syndrome (LAS) in 1982-1983 in Atlanta, CA, and 21
matched seronegative controls were evaluated with
detailed neuropsychologic testing in 1986 and 1987.
Results. In 1986, LAS patients (mean duration of LAS=4.0
years) showed mild deficits relative to controls in
language, memory, attention, and visual and auditory
processing. In 1987 (mean follow-up=1.4 years),
neuropsychologic profiles for patients and controls were
generally stable. Group profiles were analyzed by
MANOVA. Patient-control status was again associated
with neuropsychologic status (F[1,39]=11.34, p=.002),
and a time effect (practice effect) was noted
(F[1,39]=13.70, p=.001), but there was no interaction of
patient-control status and change in neuropsychologic
status over time (F[1,39]=2.23, ns). Clinically, there
was no evidence of decline for most patients. Cognitive
status did not correlate with immunologic function,
affective state, or duration of LAS.
Conclusion. These findings support the presence of a
consistent pattern of neuropsychologic dysfunction in
HIV infection in LAS patients. Mild congnitive changes
were not predictive of rapid deterioration as described
in AIDS patients with dementia.

8570
PSYCHIATRIC RAMIFICATIONS OF THE AIDS PANDEMIC:
AN OVERVIEW
West, L.J., Fawzy, F.I., and West, K.L.
UCLA School of Medicine, Los Angeles, California
Except for the basic virology of AIDS, there are
significant psychosocial factors relevant to all other
aspects of the pandemic. These include: 1) dynamics of
sexual and drug abuse practices contributing to viral
spread; 2) psychiatric symptoms due to neural lesions;
3) psychiatric complications of AIDS-related debilitating
diseases; 4) other psychiatric consequences of being an
AIDS patient, including mortality, interpersonal rejection
("leper syndrome"), guilt, etc.; 5) possible effects of
psychosocial adaptational factors on host resistance;
6) symptoms deriving from fear of AIDS in those (including
patients previously transfused, and certain health care
personnel) without the disease but at risk because of
possible exposure; 7) apprehensions by those not exposed
but fearful for other reasons; and 8) strategies for
therapeutic intervention at all levels: individual, group
and family therapies, institutional/organizational
consultations, educational programs, and formulations of
public policy. In context of the foregoing, experience
with interventions to improve coping behaviors of both
AIDS patients and their caretakers will be described.

Notes:

8571 INITIAL PSYCHIATRIC DIAGNOSES AND SUBSEQUENT
DEVELOPMENT OF AIDS DEMENTIA COMPLEX
Jaime Smith*
*St. Paul's Hospital, Vancouver, Canada
Objective. To describe the results of first-contact
psychiatric consultation in hospitalized AIDS patients
in terms of diagnostic category, treatment modalities,
and clinical outcome, particularly with respect to the
cdevlopi2-nt of AIDS Dementia Complex (ADC).
Methods. 55 patients with CDC criterion AIDS, all now
deceased, were seen in psychiatric consultation at the
request of an internist or family physician during the
course of hospitalization for treatment of AIDS related
opportunistic infection or neoplasm. Each patients'
chart was reviewed to determine initial psychiatric
diagnosis, treatment instituted (if any) and subsequent
development of AIDS Dementia Complex.
Results. Specific DSM-III-R diagnostic categories were
employed to assign diagnoses. The following table
groups principal diagnoses into broader headings:
Diagnosis N ADC
No Psychiatric Disorder 6
Organic Mental Disorder 10 10
Adjustment Disorder 9 3
Affective Disorder 9 3
Personality Disorder 6 0
Conclusion. Initial psychiatric diagnosis, aside from
that of Organic Mental Disorder, is a poor predictor of
AIDS Dementia Complex. More refined methods such as
neuropsychological testing have been shown to yield
morp useful results in terms of outcome prediction.
A high percentage of initial psychiatric referrals uo
not appear to arise out of psychopathology per se in the
patient.

8572 THE FEAR OF AIDS:PSYCHIATRIC SYMPTOM
0 OR SYNDROME?
K.S.Jacob, Jacob K. John,Abraham Verghese,T.
Jacob John. Christian Medical College Hospital,
Vellore, India.
OBJECTIVE:To study the clinical characteristics
of patients who present with the fear of AIDS
although they are negative for the antibody
against the AIDS virusMETHODS:A clinical study of twelve male patients
who referred themselves for AIDS screening was
done. They were tested by the ELISA technique
and found to have no antibody against the AIDS
virus.
RESULTS:The common clinical features included
an anxious neurotic premorbid personality, a
history of promiscous heterosexual contact,signs and symptoms of an anxiety state which was
precipitated by a minor physical illness. They
scored low on extraversion and high on neuroticism as measured by the Eysenck Personality
Questionnaire.
CONCLUSIONS:This report differs from western literature which document a diagnostically heterogeiis group of patients with a predominantly
homosexual orientation. This can be explained
based on the sampling bias seen with our sample
and on the sociocultural and other differences
seen in the Indian population. The issue raised
by these differences would be the appropriateness of the term AIDS phobia, AIDS panic and
Psuedo AIDS which have been used to describe
this condition. Classification of patients based on yptoms rather than syndromes can lead
to suc iscrepancies.

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