HIV and Psychiatry: Training and Resource Manual

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Contributors......Page 11
Preface......Page 15
World......Page 17
Sexual......Page 18
Maternal–fetal......Page 19
What is the pathogenesis of HIV infection?......Page 20
How is a diagnosis of HIV infection made, and how is HIV infection classified?......Page 21
Primary HIV infection......Page 22
Oral and skin manifestations......Page 23
Gastrointestinal manifestations and multi-organ system disease......Page 25
Neurocognitive and neurologic manifestations......Page 26
History......Page 27
Laboratory studies......Page 31
How is HIV infection managed?......Page 32
Adherence......Page 34
Modification of regimen......Page 37
Long-term toxicities......Page 39
Principles of use......Page 41
Suggested reading......Page 44
Web Sites......Page 45
What causes the cognitive dysfunction associated with HIV infection?......Page 46
What nomenclature is used to describe the neurobehavioral disorders that occur in HIV infection?......Page 47
What are the characteristics of HACM?......Page 48
What is the course of illness?......Page 49
What is the relationship between cognitive complaints and depression?......Page 51
When should a psychiatrist consider neuropsychological testing?......Page 52
What are the characteristics of HIV-associated dementia complex (HADC)?......Page 53
Which elements in this history are important in establishing the diagnosis?......Page 54
What is the differential diagnosis and how can the physician narrow it?......Page 56
What other investigations are necessary to establish a diagnosis?......Page 57
Could the symptoms be caused by the substances that the patient is using?......Page 58
What mental status screening and assessment tools should be used?......Page 59
Are there specific treatments for HACM?......Page 60
Epilogue......Page 63
What impact does HADC have on behavior?......Page 64
Are there nonpharmacological interventions that should be considered in the management of HADC?......Page 65
What is the prognosis for a person presenting with HADC?......Page 67
References......Page 68
Introduction......Page 72
What is the main mechanism responsible for interactions between antiretrovirals and .........Page 74
What are the clinical implications of these pharmacokinetic interactions?......Page 75
What medications used in HIV care (other than antiretrovirals) can have an impact on the metabolism of psychotropic medications?......Page 77
Are there significant interactions between antiretrovirals and alternative products (herbal medicines)?......Page 82
How can antiretrovirals interact with opiate medications?......Page 83
Are there significant interactions between antiretrovirals and recreationally used/abused substances?......Page 85
What types of neuropsychiatric side effects have been associated with the use of antiretrovirals and other agents used in HIV infection?......Page 88
How does one choose a psychopharmacological agent for a patient with HIV infection?......Page 89
Major depressive disorders......Page 90
Bipolar disorders......Page 92
Anxiety disorders......Page 95
Psychotic disorders......Page 96
Sleep disorders......Page 97
What precautions should a clinician take in order to safely prescribe medications in an HIV-infected individual?......Page 98
Conclusion......Page 99
References......Page 100
Suggested Reading......Page 103
Introduction......Page 104
What is the differential diagnosis?......Page 105
What are the risk factors for the development of depression and suicidality?......Page 106
What are the risks associated with untreated depression?......Page 107
What is the nonpharmacological management of depressive disorders in people with HIV?......Page 108
What is the differential diagnosis?......Page 109
Which opportunistic infections may induce or mimic depression?......Page 111
Medication interactions......Page 112
Which antidepressants should be used in this population?......Page 113
What is the differential diagnosis of mania in HIV?......Page 115
Would the diagnostic considerations have been different if the patient had presented with psychosis in the absence of prominent mood symptoms?......Page 116
Mood stabilizers......Page 117
Antipsychotics......Page 118
Other......Page 119
Conclusion......Page 120
References......Page 121
Suggested reading......Page 124
Introduction......Page 126
How should clinicians assess deliberate self-harm in a person with HIV infection?......Page 127
What are the factors associated with an increased risk of deliberate self-harm in people with HIV infection?......Page 128
What are the different aspects of social support that should be explored as part of an assessment for suicidal ideas?......Page 130
What can psychiatrists do when asked to assist with suicide?......Page 131
What is the role of the psychiatrist in the care of partner and other relatives?......Page 133
Suggested reading......Page 134
Introduction......Page 136
What are the benefits to a patient of distinguishing accurately between normal anxiety and an anxiety disorder?......Page 137
What factors should be considered in psychotherapy for patients with anxiety disorder?......Page 138
Can underlying medical disorders or HIV itself cause anxiety?......Page 139
Recommended treatment strategy......Page 141
References......Page 142
Introduction......Page 144
What is Mark's diagnosis?......Page 145
What is the differential etiology of the delirium?......Page 146
What is the treatment for delirium?......Page 147
How are sleep problems addressed in the hospital setting?......Page 148
How should Mark's pain be managed?......Page 150
References......Page 152
Introduction......Page 154
How is an HIV risk assessment conducted?......Page 155
What are the special issues involved in HIV testing of people with serious and persistent mental illness?......Page 158
How are people with serious and persistent mental illness likely to react to a diagnosis of HIV infection?......Page 159
What are the most common risks for HIV infection in psychiatric patients?......Page 160
Environmental and social factors......Page 161
What are the special issues involved in the follow-up of people with HIV who also have serious and persistent mental illness?......Page 162
What are the determinants of HIV risk reduction among psychiatric patients?......Page 163
How can psychiatrists help patients reduce their risk of transmitting or acquiring HIV?......Page 165
Conclusion......Page 166
References......Page 167
Introduction......Page 169
What is the therapist's responsibility in pointing out potentially dangerous behaviors to patients?......Page 170
What issues impact on a person's ability to adhere to safer sex practices?......Page 171
What approach should the therapist take when the patient engages in high-risk behaviors?......Page 172
What types of intervention are helpful soon after HIV is diagnosed?......Page 173
What potential roles does psychodynamic psychotherapy have in treating persons with HIV?......Page 174
What are some of the expected transference issues which might emerge in a dynamic therapy with someone with HIV?......Page 175
What are some of the expected countertransference issues that might emerge in a dynamic therapy?......Page 176
How does ambivalence relate to living with HIV infection?......Page 177
What issues figure prominently in the psychotherapy of long-term survivors with HIV infection?......Page 179
What is the role of interpersonal psychotherapy in treating people with HIV infection?......Page 180
What issues does the patient face in dealing with long-term side effects of HIV treatment?......Page 181
What are the spiritual issues for someone faced with HIV disease?......Page 182
What are the implications for psychotherapy when it moves to the person's home?......Page 184
Suggested reading......Page 185
Introduction......Page 186
How does antiretroviral therapy affect methadone metabolism?......Page 189
Can the presence of psychiatric comorbidity affect the patient's ability to adhere to treatment?......Page 190
In a patient not already involved with the healthcare system (i.e., methadone maintenance), how would the intervention have been different?......Page 191
What is the Stages of Change model?......Page 192
To what extent does alcohol abuse influence adherence to treatment?......Page 193
Motivation......Page 194
Conclusion......Page 195
Suggested reading......Page 196
Introduction......Page 197
What neurocognitive disorders are seen in young children with HIV?......Page 198
What is the standard evaluation of a child suspected of having neurocognitive impairment secondary to HIV?......Page 199
What other treatments are effective for managing HACM?......Page 200
How do depressed HIV-seropositive children and adolescents typically present?......Page 201
What should be included in the evaluation of an HIV-seropositive child or adolescent with depression?......Page 202
What principles should be followed when prescribing psychotropic medications for depressed HIV-infected children and adolescents?......Page 203
What types of psychotherapy and systemic interventions are useful for depressed children and adolescents with HIV?......Page 204
How can mental health professionals help an HIV-seropositive child cope with the death of a parent?......Page 205
What adherence issues are seen among HIV-positive children and adolescents?......Page 206
Which techniques facilitate adherence in children and adolescents?......Page 207
How do you prepare a child for disclosure?......Page 208
How do you prepare a child and family to transfer from a pediatric setting to an adult setting?......Page 209
References......Page 210
Web sites......Page 211
Introduction......Page 212
How should a clinician approach a young child who is HIV affected?......Page 213
What cultural issues should the clinician consider when treating children of HIV-positive parents?......Page 214
How might Angela's life have been different if she had an HIV-seropositive sibling? Is there .........Page 215
What are the countertransference issues the therapist may have been dealing with?......Page 217
How has the course of treatment changed in parts of the world where HIV medications are available?......Page 218
Suggested reading......Page 219
Introduction......Page 220
The issue of gender identity......Page 222
How do shame and stigma concerning early childhood gender-nonconformity affect psychological development?......Page 223
How does growing up gay lead to inhibition and the splitting off of sexuality from relationships?......Page 226
What is the specific importance of adolescence in gay male development?......Page 227
What specific developmental issues exist for gay men as they move from adolescence to adulthood?......Page 228
What issues should a gay man with HIV consider when deciding to raise a child?......Page 229
References......Page 230
What are the risk factors for HIV transmission in women?......Page 233
What is the impact of HIV on women, sex, and relationships?......Page 235
Do women respond differently than men to HIV treatments?......Page 236
What factors can influence adherence in women?......Page 237
What parenting issues do HIV-positive women face?......Page 238
What are the reproductive/sexual health concerns of HIV-positive women?......Page 239
What is involved in the diagnosis and care of pregnant women with HIV?......Page 240
What are the effects of HIV diagnosis during pregnancy?......Page 241
HIV positive......Page 242
What are women's concerns about wider family infection?......Page 243
What are the guiding principles for planning care?......Page 244
What are the issues surrounding the concept of women and power?......Page 246
References......Page 248
Introduction......Page 252
What impact can HIV infection have on sexuality in a couple?......Page 253
How can clinicians maintain confidentiality in couple therapy?......Page 254
What effect can adherence to antiretroviral medications have on a couple?......Page 255
What impact does caregiving have on the couple?......Page 256
What is the emotional impact on caregivers?......Page 257
How important is social support?......Page 258
Are partners of individuals with HIV at increased risk of suicide?......Page 259
Are there specific issues for gay couples?......Page 260
Are there specific difficulties for couples who are both positive?......Page 261
References......Page 262
Introduction......Page 264
How does cultural diversity affect assessment?......Page 265
How does cultural diversity affect treatment planning?......Page 266
References......Page 267
Introduction......Page 269
What are some of the historical factors that account for the difficulty many African Americans have in trusting the medical establishment?......Page 270
How do racial differences affect the ability to develop a therapeutic relationship?......Page 271
How can the psychiatrist help address issues of adherence when working with African American patients?......Page 272
What additional issues need to be considered when working with African American women with HIV?......Page 273
What is the significance of child bearing and child raising in the African American community?......Page 274
What are the issues facing African American men who have sex with men?......Page 275
Conclusion......Page 276
Websites......Page 277
Introduction......Page 279
How important is the family for HIV-positive Latinos?......Page 280
How would the situation be different for Benito if he were heterosexual?......Page 281
What can the clinician do to increase adherence?......Page 282
How do the personal responsibilities of Latinas with HIV affect their medical care?......Page 283
What coping resources can Latinas with HIV draw on to help them live with their diagnosis and concomitant stressors?......Page 284
Conclusion......Page 285
Web Sites......Page 286
Introduction......Page 288
What impact has HIV infection had on Native communities?......Page 290
What is the Native concept of sexuality and gender?......Page 291
What is the basis for Native mistrust of non-Natives?......Page 292
What kind of traditional ceremony can be helpful to Native patients?......Page 293
Are there traditional ceremonies that could be useful to Marie and her daughter?......Page 295
What are some strategies for working with Native patients?......Page 296
Conclusion......Page 297
Suggested Further Reading......Page 298
Introduction......Page 299
What should be included in the initial medical assessment of an inmate?......Page 301
How should correctional institutions approach HIV testing?......Page 302
How can healthcare providers influence an inmate's behavior?......Page 303
Are there any circumstances where an inmate's HIV status should be disclosed to prison staff?......Page 305
What impact does the prison environment/culture have on healthcare?......Page 306
References......Page 307
Can George be denied admission based on his HIV-serostatus and the potential risk he represents to other patients?......Page 309
Can George's HIV status be disclosed to other patients?......Page 310
How can the hospital protect other patients and staff from the risk of being infected by George?......Page 311
In the midst of an epidemic of such proportion, why is there such a strong emphasis on confidentiality and protection of the rights of the individual?......Page 312
Can Laura's partners be notified of her diagnosis?......Page 313
What is the clinical approach to a patient with HIV who puts others at risk?......Page 314
What can be done about patients who will not change their behaviour and seem to disregard the safety of others?......Page 315
What are the legal issues that Marc should be addressing?......Page 316
Are there any particular considerations for people with advanced HIV disease who want to write a will?......Page 317
What are some of the psychosocial factors that may affect competence to refuse life-saving measures?......Page 318
What are some of the factors specifically related to HIV infection that can complicate a competency assessment?......Page 320
References......Page 321
Suggested further Reading......Page 322
Introduction......Page 323
What are the sources of the psychiatrist's discontent?......Page 324
How can the psychiatrist approach his own countertransference issues with a patient?......Page 325
What are the potential long-term consequences of the psychiatrist's discontent?......Page 326
What personal interventions are important for professional self-care?......Page 327
What organizational interventions are important for professional self-care?......Page 328
How does the death of the patient affect the psychiatrist?......Page 329
Conclusion......Page 331
References......Page 332
Organizations specializing in physician stress......Page 333
Websites with information on physician burnout......Page 334
Post-test counseling......Page 335
Other important issues (emphasize early if poor follow-up is likely)......Page 336
Index......Page 337