Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions

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dc.contributor.advisorLehloenya, Rannakoe J.en_ZA
dc.contributor.advisorMuloiwa, Rudzanien_ZA
dc.contributor.advisorChiliza, Bonginkosien_ZA
dc.contributor.authorZitha, Eddyen_ZA
dc.date.accessioned2016-08-19T13:18:57Z
dc.date.available2016-08-19T13:18:57Z
dc.date.issued2016en_ZA
dc.description.abstractBackground: There is limited data on anxiety and depression in subjects with severe cutaneous adverse drug reactions (SCADR), in a predominantly HIV - infected population. The aim of the study was to prospectively investigate the prevalence of anxiety and depression and quality of life in patients with SCADR. Methods: In this prospective study, SJS, SJS - TEN, TEN and DRESS patients were assessed for anxiety and depression using validated scoring systems, the Hospital Anxiety and Depression Scale (HAD S), and the Dermatology Life Quality Index (DLQI). This was done at six weeks post discharge and again at six months follow - up. Results: Forty - eight patients with SCADR were enrolled at six weeks and 37/48 (77%) completed the study at six months. The populations were similar demographically at six weeks and six months. At six weeks anxiety or borderline anxiety symptoms/caseness was identified in 25/48 (52%) SCADR patients and depression or borderline depression symptoms/caseness in 24/48 (50%). Of those with symptoms, 18 were assessed as having co - morbid anxiety and depression with only 2 cases of pure anxiety and 4 of pure depression. At six months only 37 patients with SCADR returned for follow - up. Four of them had died in the interim while the other seven relocated. Of the cases of pure anxiety; one resolved and one was lost to follow - up. Of the cases of pure depression; one resolved, one persisted, one converted to comorbid anxiety and depression and one was lost to follow - up. Of those with co - morbid anxiety and depression 10 persisted, 2 converted to pure depression, 3 normalised and 2 were lost to follow - up. One previously normal patient developed anxiety symptoms and one case developed comorbid anxiety and depression. In 9/13 (69%) of the patients with SJS, SJS - TEN and TEN, co - morbid anxiety and depression persisted from week six to 6 months. In contrast in only 1/5 (20%) of the patients with DRESS, co - morbid anxiety and depression persisted from week six to 6 months. The cases of pure anxiety and depression were too small for meaningful comment. The overall SJS, SJS - TEN and TEN had median DLQI 8.4 relative to DRESS (DLQI 7.5) at six weeks. However, TEN (DLQI 14) had a greater impact on the quality of life compared to SJS (DLQI 3) and DRESS (DLQI 7.5). This pattern was maintained at six months. Conclusion: Anxiety and depression in patients with SCADR in a predominantly HIV - infected population is present. In the majority of cases, depression and anxiety coexist in patients with SCADR. These are sustained for at least 6 months post discharge. SCADR has a negative impact on quality of life. Our findings should help to improve the awareness of the impact of severe cutaneous adverse drug reactions on mental health especially as this may impact on future treatment adherence.en_ZA
dc.identifier.apacitationZitha, E. (2016). <i>Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/21378en_ZA
dc.identifier.chicagocitationZitha, Eddy. <i>"Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016. http://hdl.handle.net/11427/21378en_ZA
dc.identifier.citationZitha, E. 2016. Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Zitha, Eddy AB - Background: There is limited data on anxiety and depression in subjects with severe cutaneous adverse drug reactions (SCADR), in a predominantly HIV - infected population. The aim of the study was to prospectively investigate the prevalence of anxiety and depression and quality of life in patients with SCADR. Methods: In this prospective study, SJS, SJS - TEN, TEN and DRESS patients were assessed for anxiety and depression using validated scoring systems, the Hospital Anxiety and Depression Scale (HAD S), and the Dermatology Life Quality Index (DLQI). This was done at six weeks post discharge and again at six months follow - up. Results: Forty - eight patients with SCADR were enrolled at six weeks and 37/48 (77%) completed the study at six months. The populations were similar demographically at six weeks and six months. At six weeks anxiety or borderline anxiety symptoms/caseness was identified in 25/48 (52%) SCADR patients and depression or borderline depression symptoms/caseness in 24/48 (50%). Of those with symptoms, 18 were assessed as having co - morbid anxiety and depression with only 2 cases of pure anxiety and 4 of pure depression. At six months only 37 patients with SCADR returned for follow - up. Four of them had died in the interim while the other seven relocated. Of the cases of pure anxiety; one resolved and one was lost to follow - up. Of the cases of pure depression; one resolved, one persisted, one converted to comorbid anxiety and depression and one was lost to follow - up. Of those with co - morbid anxiety and depression 10 persisted, 2 converted to pure depression, 3 normalised and 2 were lost to follow - up. One previously normal patient developed anxiety symptoms and one case developed comorbid anxiety and depression. In 9/13 (69%) of the patients with SJS, SJS - TEN and TEN, co - morbid anxiety and depression persisted from week six to 6 months. In contrast in only 1/5 (20%) of the patients with DRESS, co - morbid anxiety and depression persisted from week six to 6 months. The cases of pure anxiety and depression were too small for meaningful comment. The overall SJS, SJS - TEN and TEN had median DLQI 8.4 relative to DRESS (DLQI 7.5) at six weeks. However, TEN (DLQI 14) had a greater impact on the quality of life compared to SJS (DLQI 3) and DRESS (DLQI 7.5). This pattern was maintained at six months. Conclusion: Anxiety and depression in patients with SCADR in a predominantly HIV - infected population is present. In the majority of cases, depression and anxiety coexist in patients with SCADR. These are sustained for at least 6 months post discharge. SCADR has a negative impact on quality of life. Our findings should help to improve the awareness of the impact of severe cutaneous adverse drug reactions on mental health especially as this may impact on future treatment adherence. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions TI - Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions UR - http://hdl.handle.net/11427/21378 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/21378
dc.identifier.vancouvercitationZitha E. Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/21378en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherMedicineen_ZA
dc.titlePrevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactionsen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMSc (Med)en_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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