Handbook of AIDS Psychiatry

Abstract

The Handbook of AIDS Psychiatry is a practical guide for AIDS psychiatrists and other mental health professionals as well as for other clinicians who work with persons with HIV and AIDS and a companion book to the Comprehensive Textbook of AIDS Psychiatry (Cohen and Gorman, 2008). The Handbook provides insights into the dynamics of adherence to risk reduction and medical care in persons with HIV and AIDS as well as strategies to improve adherence using a biopsychosocial approach. Psychiatric disorders can accelerate the spread of the virus by creating barriers to risk reduction. Risky sexual behaviors and sharing of needles in intravenous drug users account for the majority of new cases each year. Delirium, dementia, depression, substance dependence, PTSD, and other psychiatric disorders complicate the course and add considerably to the pain and suffering of persons with AIDS. HIV infection and AIDS also are risk factors for suicide, and the rate of suicide has been shown to be higher in persons with AIDS. Psychiatric care can help prevent HIV transmission through recognition and treatment of substance-related disorders, dementia, and mood disorders such as mania. Comprehensive, coordinated care by a multidisciplinary AIDS team, including AIDS psychiatrists, can provide a biopsychosocial approach that is supportive to patients, families, and clinicians. Psychiatric interventions are valuable in every phase of infection, from identification of risk behaviors to anticipation about HIV testing; from exposure and initial infection to confirmation with a positive HIV antibody test; from entry into systems of care to managing complex antiretroviral regimen; from healthy seropositive to onset of first AIDS-related illness; from late stage AIDS to end-stage AIDS and death. There is no comprehensive handbook of AIDS psychiatry to guide clinicians in providing much needed care. The Handbook of AIDS Psychiatry is a practical pocket guide that provides protocols for the recognition and treatment of the psychiatric disorders most prevalent in persons with AIDS and most relevant for primary physicians, infectious disease specialists, and other caregivers because of their impact on health, adherence, behavior, and quality of life.

The Definition and Scope of HIV Psychiatry: How to Provide Compassionate Care

“…Psychotherapy can be a helpful therapeutic intervention for processing and addressing the psychological distress of living with a chronic systemic medical illness, such as HIV and AIDS. The emotional distress of living with HIV and AIDS can be viewed as secondary to biological aspects of the disease as well as to more direct biopsychosocial factors [1][2][3][4][5][6]31]. The factors involved with distress in persons with HIV are summarized in Table 1 multidisciplinary approach that is highly dependent on available resources.…”

“…Mood-stabilizing anticonvulsants and some antidepressants have pharmacokinetic properties that may interfere with tolerable and effective antiretroviral therapy. When choosing psychotropic medications, clinicians need to be aware of side effects, toxicities, and potential drug-drug and drug-illness interactions [1][2][3][4][5][6].…”

“…HIV/AIDS psychiatry is defined as the sub-subspecialty of consultation-liaison psychiatry that focuses on prevention, care, and treatment of HIV and AIDS; psychiatric aspects of risk behaviors and their antecedents; psychiatric manifestations of HIV and its stigma; psychological consequences of HIV infection and its multimorbidities and their impact on persons infected with and affected by HIV; and the imperative for an integrated biopsychosociocultural approach to prevention, care, and adherence [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…This comprehensive compassionate care of persons with HIV is exemplified in the concept of a biopsychosociocultural approach as first applied to HIV and AIDS by Cohen and Weisman [3]. In this chapter, we will illustrate the importance of compassion and a comprehensive biopsychosociocultural approach [1][2][3][4][5][6]. Persons with HIV/AIDS are seen from the standpoint of their systemic medical illnesses, comorbid psychiatric illnesses, and psychological responses to illness.…”

HIV Stigma

“…While this treatment cascade has multiple biopsychosocial determinants [1][2][3][4][5][6][7][8][9][10], HIV stigma, AIDSism [11], and resultant discrimination contribute to HIV transmission, nonadherence to care, and morbidity and mortality in persons with HIV. HIV stigma has been defined by the US Centers for Disease Control and Prevention (CDC) and UNAIDS [12][13][14].…”