Effects of psychosocial factors on the course of disease

Links between brain and behaviour and between psychiatry and medicine are well illustrated by the substantial research on the influence of psychosocial factors on the course of HIV infection and AIDS.(44> Sustained depressed mood and negative expectancies, especially when complicated by bereavement, are associated with more rapid decline of CD4+ helper T cells and an increase in other markers of progression (such as the activation marker b 2-microglobulin), as is lack of open acknowledgment of sexual orientation (being 'in the closet'). Passive coping (including denial and disengagement) is inversely related to long-term CD4 cell count.

Long-term survivors with clinical AIDS and those who remain asymptomatic for prolonged periods of time in the face of very low CD4 counts seem to be those who have good coping skills, lead meaningful lives, find new meanings as a result of illness, are relatively not distressed, and are emotionally expressive and assertive. HIV-associated dementia, which is reversible in its early stages, appears to be closely related to the action of proinflammatory cytokines, particularly tumour necrosis factor, on neurones. Psychiatric symptoms, as well as cognitive defects, probably also cytokine induced, also occur in conjunction with HIV infection (primarily of microglia) of the brain; they include apathy, withdrawal, psychosis, and regressive behaviours.

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