tion of these issues is particularly important for maintaining patient compliance throughout treatment and for future medical management ( Frost, 1985).
Pharmacological interventions, particularly where depression is the underlying disorder, may be of value; although they, too, pose a dilemma. Those medications traditionally used for depressive or obsessive states usually produce marked side effects to therapeutic doses which tend to exacerbate patients' fears and hypochondriacal dispositions, given their somatic sensitivities. On the other hand, the severity of presentations often makes immediate pharmacological intervention seem necessary. Short-term anxiolitic prescriptions, betablockers, or low-dose neuroleptic prescriptions may be of use somatically, but do little to intercept obsessive content. Behavioral psychotherapy may assist where background vulnerability and relationship disturbances, arising from the fears of HIV disease, exist; and, in some cases, psychiatric admission will be required, particularly where suicidal risk is prominent ( Miller, 1986a; 1986b).
The need for acute psychiatric admission protocols for this population is particularly evident, given the high level of suicidal planning and activity within the groups surveyed. Additionally, appropriately trained psychiatric staff acting in a liaison capacity with STD or GUM clinics must be available for early recognition and intervention.
This brief series of patients reveals consistent presenting and background psychological phenomena in the population of worried well, presenting in the context of the HIV pandemic. This group also conforms to the psychiatric classification of hypochondriasis, and these consistencies lead to a number of clinical options in a patient group with considerable management difficulties. The consistency in presenting and background features within this population enables early clinical identification of chronic psychosocial vulnerability and likely chronic management difficulty in those attending for HIV antibody testing, particularly following heightened media coverage of HIV/AIDS. Further, with the development of promising treatment packages for hypochondriasis, particularly from the cognitive/behavioral psychotherapy paradigm, the scope for affective clinical interventions complementing the traditional interventions for depression and obsessive disorders is becoming increasingly wide. Clearly, with identification of this important clinical group becoming more reliable, the need for sustained evaluation of such interventions is paramount.
Portions of this study were first presented at the IIIrd International Conference on AIDS, Washington, D.C., June 1-5, 1987. The author thanks Drs. Barbara Hedge and Ulrike Schmidt (Academic Department of Psychiatry, The