title: Understanding the psychodynamics of non-adherence to medical treatment in persons with HIV infection.
abstract: We present this medical-psychiatric case discussion to illustrate the psychodynamic aspects of nonadherence in a woman with AIDS. Our patient sustained severe, repeated abandonment and brutal emotional, physical and sexual trauma throughout her early and later childhood and adult life. Her care was considerably complicated by the sequelae of trauma including difficulty with trust and posttraumatic stress disorder. The additional problem of HIV dementia compounded the patient's nonadherence to treatment. We present a multidisciplinary biopsychosocial approach that enabled the patient to engage in both medical and psychiatric care.
authors.affiliation: Mount Sinai Hospital, New York, NY, USA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ricart
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Cohen
authors.forename: César A
authors.initials: CA
authors.lastname: Alfonso
authors.forename: Rosalind G
authors.initials: RG
authors.lastname: Hoffman
authors.forename: Nancy
authors.initials: N
authors.lastname: Quiñones
authors.forename: Alan
authors.initials: A
authors.lastname: Cohen
authors.forename: Debbie
authors.initials: D
authors.lastname: Indyk
mesh_terms: D015526:AIDS Dementia Complex / Q000209:etiology; D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology* / Q000628:therapy*; D000328:Adult; D005260:Female; D006679:HIV Seropositivity / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D010348:Patient Care Team; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology*; D016312:Treatment Refusal