Journal of Psychosocial Nursing and Mental Health Services
Vol. 46 No. 11 November 2008
Suicidal Ideation in Adults Aging with HIV: Neurological and Cognitive Considerations
David E. Vance, PhD, MGS; Linda Moneyham, DNS, RN, FAAN; and Kenneth F. Farr, MS, CNS-BC
ABSTRACT
Because of highly active antiretroviral therapy, people are now aging with HIV. Several stressors associated with aging with HIV may result in increased levels of depression and suicidal ideation. In addition, neurological and cognitive changes that often accompany both aging and HIV must be considered because those aging with HIV are at greater risk of developing such problems. These problems may be reflected in executive functioning deficits and initiation and perseveration difficulties. Adults experiencing such problems may be predisposed to ruminative thoughts that can impair the ability to effectively cope with the stressors associated with aging with HIV. Moreover, other conditions such as posttraumatic stress disorder, chronic drug use, and mitochondrial-damage-related fatigue can predispose these adults to the development of further neurological and cognitive problems. These problems may foster further ruminative thinking and increase the severity of depression and suicidal ideation. Implications for nursing practice, intervention, and research are provided.
AUTHORS
Dr. Vance is Assistant Professor, Dr. Moneyham is Professor and Rachel Z. Booth Endowed Chair, and Mr. Farr is Instructor and Clinical Nurse Specialist, Adult and Geriatric Psychiatric/Mental Health Nursing, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to David E. Vance, PhD, MGS, Assistant Professor, School of Nursing, G010B, 1701 University Boulevard, University of Alabama at Birmingham, Birmingham, AL 35294-1210; e-mail: devance@uab.edu.
Late-Onset Posttraumatic Stress Disorder
Marsha Snyder, PhD, PMHCNS, BC
ABSTRACT
Posttraumatic stress disorder (PTSD) is a complex psychological response to a perceived life-threatening trauma that includes re-experiencing the trauma, avoidance, intrusive thoughts, hyperarousal, and dissociation. Exposure to trauma in early adulthood increases the potential for further psychological threats throughout life. In older adult populations, PTSD is an underrecognized and undertreated disorder that can result in psychosocial disability, substance use, and other negative health outcomes. This article examines the range of symptoms related to PTSD in older adults and expands on health care provider sensitivity to the interrelationship of mental and physical health when addressing the needs of older adults with this disorder.
AUTHOR
Dr. Snyder is Clinical Assistant Professor, University of Illinois at Chicago, Department of Health Systems Science, Chicago, Illinois.
The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Marsha Snyder, PhD, PMHCNS, BC, Clinical Assistant Professor, University of Illinois at Chicago, Department of Health Systems Science, 845 South Damen Avenue, Chicago, IL 60612-7350; e-mail: snyderm@uic.edu.
Psychosis in Late Life: Emerging Issues
Roy R. Reeves, DO, PhD; and James C. Brister, MD
ABSTRACT
Psychotic symptoms in older individuals may be more common than was previously thought. Most kinds of psychosis that occur in younger people can be seen in older patients. However, there are important clinical differences between early-onset and late-onset psychosis. Conditions in which psychotic symptoms may occur in older adults include chronic illnesses such as dementia, schizophrenia, and delusional disorder, and acute transient disorders such as delirium and substance-induced psychosis. In this article, we focus on psychosis in chronic disorders in older individuals and discuss presentation and treatment of psychosis in patients with early-onset schizophrenia who have lived into old age, late-onset schizophrenia, very late-onset schizophrenia-like psychosis, delusional disorder, and Alzheimer’s disease and other dementias.
AUTHORS
Dr. Reeves is Associate Chief of Staff for Mental Health and Dr. Brister is a staff psychiatrist, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi. Dr. Reeves is also Professor of Psychiatry and Neurology and Dr. Brister is also Assistant Professor of Psychiatry, University of Mississippi School of Medicine, Jackson, Mississippi.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Roy R. Reeves, DO, PhD, Associate Chief of Staff for Mental Health (11M), G.V. (Sonny) Montgomery VA Medical Center, 1500 East Woodrow Wilson Drive, Jackson, MS 39216; e-mail: roy.reeves@med.va.gov.
