A randomized, double-blind, placebo-controlled trial of psychostimulants for the treatment of fatigue in ambulatory patients with human immunodeficiency virus disease.

Background: Fatigue is a commonly encountered symptom of human immunodeficiency virus (HIV) disease, associated with significant psychological and functional morbidity and poor quality of life. Preliminary studies on the treatment of fatigue from the cancer and multiple sclerosis literature suggest that psychostimulants may be effective in reducing fatigue.

Objective: To compare the efficacy of 2 psychostimulant medications, methylphenidate hydrochloride (Ritalin) and pemoline (Cylert), with a placebo intervention for the treatment of fatigue in patients with HIV disease.

The schedule of attitudes toward hastened death: Measuring desire for death in terminally ill cancer patients.

Background: The authors examined the reliability and validity of the Schedule of Attitudes toward Hastened Death (SAHD), a self-report measure of desire for death previously validated in a population of individuals with the acquired immunodeficiency syndrome (AIDS), among terminally ill patients with cancer.

Methods: The authors interviewed 92 terminally ill cancer patients, all with a life expectancy of < 6 months, after admission to a palliative care hospital. Patients were administered the SAHD, a clinician-rated measure of desire for death (the Desire for Death Rating Scale [DDRS]), and several measures of physical and psychosocial well-being.

Patient-related barriers to pain management in ambulatory AIDS patients.

A number of studies have demonstrated that pain is dramatically undertreated among patients with AIDS and that opioids in particular are rarely prescribed. To date, however, there has been no systematic attempt to examine patient-related barriers to the management of pain in AIDS. This study examines potential patient-related barriers to pain management in patients with AIDS using the Barriers Questionnaire (Ward et al.

A comparison of pain report and adequacy of analgesic therapy in ambulatory AIDS patients with and without a history of substance abuse.

Concerns are often raised regarding the credibility of patients' report of pain and this concern is heightened among individuals with AIDS, where many patients have a history of injection drug use. This study compared the pain experience, adequacy of pain management and psychological well-being among patients with AIDS who reported a history of injection drug use (IDU) as their HIV transmission risk factor and patients with other HIV transmission risk factors. Five hundred and sixteen ambulatory AIDS patients participating in a quality of life study completed a series of self-report instruments including the Brief Pain Inventory, the Beck Depression Inventory, the Brief Symptom Inventory, the Functional Living Inventory and the Social Support Questionnaire.