HIV Psychiatry: A Practical Guide for Clinicians

Foreword
Preface
Contents
Contributors
Chapter 1: The Definition and Scope of HIV Psychiatry: How to Provide Compassionate Care
	Psychiatric Disorders
	Psychiatric Disorders and Adherence to HIV Care
	Psychiatric Treatment Modalities for Persons with HIV and Psychiatric Disorders
		Psychotherapy
		Integrative Medicine Modalities
		Psychopharmacology
	HIV Risk Behaviors: Recognition and HIV Prevention
	Collaborative Care, Prevention of HIV, and Improvement of Clinical Outcomes
	Multiple-Choice Questions and Associated References
	References
Chapter 2: HIV Testing and Prevention
	Introduction
	Public Health Strategies for HIV Prevention
		Treatment as Prevention
		Pre-exposure Prophylaxis
		Post-exposure Prophylaxis
	Factors That Increase HIV Risk in People with Psychiatric Illness
	HIV Risk Assessment, Screening, and Testing Patients with Psychiatric Illness
	PrEP for Persons with Mental Illness
	Post-Exposure Prophylaxis
	Conclusions
	Multiple-Choice Questions
	References
Chapter 3: HIV Stigma
	Introduction
	Impact of HIV Stigma on Patients
		HIV Testing
		Obtaining Test Results
		Disclosure
		Accepting Referral for Care
		Engagement in Care
		Accepting Recommendations for PrEP
		Adherence to PrEP
		Missing Clinic Appointments
		Nonadherence with Medications
		Treatment Cascade Versus Viral Suppression
		Delay in Beginning a 28-Day Course of PEP
	Impact of HIV Stigma on Healthcare
		Multiplicity of HIV-Associated Stigma
			HIV
			Psychiatric Illness and Addictophobia
			Homophobia
			Race and Ethnicity
			Gendered Stigma and the Effects of Gender-Based Violence
	Practical Guidelines and Approaches to Reducing Stigma in Healthcare Settings
		Strong Confidentiality Protections
		Cultural Sensitivity
		Patient-Centered Care and Communication
		Emotional Support
	Conclusion
	Questions
	References
Chapter 4: Consultation, Assessment, and Evaluation
	Outpatient Consultation
	Inpatient Consultation
	Potential Members of Care Team for Persons with HIV/AIDS
	Communication with Other HIV/AIDS Care Clinicians
	Culture, Structural Competence, and Managing Stigma
	Consultation, Assessment, and Evaluation
		Screening for Neuropsychiatric Conditions
		Screening for Trauma
		Screening for Depressive Disorders
		Screening for Substance-Related and Addictive Disorders
		Screening for Neurocognitive Impairment
		Screening for Suicidality
		Screening in Unique Populations of People with HIV/AIDS
		Postpartum Women (Table 4.10)
	Assessing Psychosocial and Psychiatric Barriers to Optimal HIV Outcomes
		Screening for HIV Transmission Risk Behavior
		Screening for HIV Medication Adherence
		Factors that Increase HIV Risk Behaviors and Nonadherence
	Psychiatric Differential Diagnosis in HIV/AIDS
		Immunosuppression and Differential Diagnosis
		Effects of Medications
		Substance-Related and Addictive Disorders and Psychiatric Symptoms
		Other Psychiatric Illnesses
	Multiple Choice Questions
	References
Chapter 5: Screening for Psychiatric Disorders in HIV Care
	Introduction
	Screening for Depression, Anxiety Disorders, and PTSD
	Screening for Alcohol and Substance Use Disorders
	The Tobacco, Alcohol, Prescription Medications, and Other Substance Tool (TAPS)
	Instructions
	Screening Tool Cutoffs and Scoring Thresholds
	Screening for HIV-Associated Neurocognitive Disorders (HAND)
	Screening for Suicide Risk
	Conclusions
	Multiple-Choice Questions
	References
Chapter 6: Depressive Disorders
	Epidemiology
		Prevalence and Risk Factors Associated with Depressive Disorders in Persons with HIV
		Risk Factors
	Diagnosis
		Tools for Assessment
	Etiology
	Clinical Interventions
		Pharmacotherapy
		Psychotherapy
		Other Therapeutic Options
	Conclusions
	Multiple-Choice Questions
	References
Chapter 7: Trauma and Stressor-Associated Disorders
	Overview: What Is Trauma?
	Association Between Trauma and HIV
	Types of Trauma Experienced by People Living with HIV/AIDS
	Impact of Traumatic Stress on HIV Outcomes
		Trauma and Adherence
		Trauma and HIV Medical Outcomes
	Practical Guidelines for Trauma-Informed Care
	Conclusions
	Multiple-Choice Questions
	References
Chapter 8: Bipolar Disorders
	Introduction
	Prevalence and Risk Factors
	Assessment and Diagnosis
	Differential Diagnosis
	Bipolar Disorder and Adherence to ART
	Pharmacological, Psychosocial Treatment, and Mobile Health Approaches
		Pharmacological Interventions
		Psychosocial Interventions
	Conclusion and Future Directions
	Multiple-Choice Questions
	References
Chapter 9: Anxiety Disorders
	Introduction
	Epidemiology
		Prevalence
	Diagnosis
		Clinical Features
		Differential Diagnosis and Diagnostic Pitfalls
			Tools for Diagnosis and Assessment
	Etiology
	Impact of Anxiety on HIV
		Sexual Transmission
		Quality of Life
		Suicidal Thoughts
		Cognitive Impairment
	Therapy
		Pharmacological Treatment
		Non-pharmacological Interventions for Anxiety Symptoms and Disorders in Persons with HIV and AIDS
	Conclusions
	Multiple-Choice Questions
	References
Chapter 10: HIV-Associated Neurocognitive Disorders and Delirium
	Part 1. HIV-Associated Neurocognitive Disorder
		Introduction and Epidemiology
		Classification and Natural History of HAND
			Natural History
		Pathophysiology of HAND: Why Is There Neurocognitive Decline Despite Effective Viral Suppression? (Fig. 10.3)
			Neuroinflammation
			Inadequate Penetration of Antiretrovirals into the CNS
			Neurotoxicity of Antiretroviral Drugs
			Section Summary
		Premature Aging, Geriatric Syndromes, and HAND
			Section Summary
		Neurocognitive Screening for HAND
			Introduction
			Selecting the Right Approach for Your Patient Population and Clinical Setting
			Conclusions Regarding Cognitive and Functional Screening
		Role of Neuroimaging and Laboratory Analysis
			Neuroimaging as a Biomarker
			Blood and CSF Markers
			Section Summary
		Basic Principles for the Management of HAND
			HAND, Comorbidities, and Functional Decline
			The Importance of a “Geriatric” Approach
			Role of Cognitive Enhancers
			Summary
	Part II. Delirium
		Introduction
		Clinical Features
		Pathophysiology
		Epidemiology
		Morbidity and Mortality
			Diagnosis
			Outpatient Delirium Prevention
			Inpatient Delirium Prevention: Non-pharmacologic and Pharmacologic
			Treatment of Delirium
			Cognitive Monitoring and Delirium Rating Scales
		Section Summary
			Conclusion
	Questions for HAND and Delirium Chapter
	References
Chapter 11: Substance-Related and Addictive Disorders
	Introduction
	Terminology and Definitions
	Assessment of Substance Use Disorders
	Substance Use Syndemic and Associated Conditions
		Trauma
		Trauma-Informed Care
		Comorbid Psychiatric Disorders
		Sexualized Drug Use
		Stigma Related to Substance Use
	Specific Substances
		Alcohol
			Prevalence and Correlates
			Effect of Alcohol on HIV
			Treatment
		Tobacco and Nicotine
			Prevalence and Correlates
			Effect of Tobacco Use on HIV
			Treatment
		Opioids
			Prevalence and Correlates
			Effect of Opioids on HIV
			Treatment
		Marijuana and Cannabis
			Prevalence and Correlates
			Effect of Marijuana on HIV
			Cannabis and Opioid Use and Misuse for Pain
			Treatment
		Cocaine and Crack Cocaine
			Prevalence and Correlates
			Effect of Cocaine on HIV
			Treatment
		Methamphetamine
			Prevalence and Correlates
			Treatment
		Club Drugs: Lysergic Acid Diethylamide (LSD), Ketamine, Gamma-Hydroxybutyrate (GHB), 3,4-Methylenedioxy-Methamphetamine (MDMA, Ecstasy)
			Prevalence and Correlates
			Treatment
		Novel Psychoactive Substances
			Cathinones
			Prevalence and Correlates
			Effect of Cathinones on HIV
			Treatment
		Synthetic Cannabinoids
			Prevalence and Correlates
			Effect of Synthetic Cannabinoids on HIV
			Treatment
	Summary of Psychosocial Treatments
	Conclusions
	Multiple Choice Questions
	References
Chapter 12: HIV and Serious Mental Illness
	Introduction
	How Common Are HIV Infection and Risk Behaviors Among People with SMI?
	Overview of Approaches to the Care of People with Comorbid SMI and HIV
		HIV Risk Assessment
		HIV Testing
		HIV Medical Services
		PrEP
		PEP
		HIV Risk-Reduction Interventions
		Efficacious Interventions and Their Active Ingredients (Table 12.7)
		Risky Situations for People with SMI
		Stigma
		Training
		HIV Care System and People with SMI
		Recovery Approach to Sexual Health
		Talking About Sex
		Understanding Sexual Side Effects of Psychiatric Medications
		Strengths-Based Supports for Preserving and Maintaining Family Relationships
		Housing to Reduce Risk and Promote Adherence to Care
	Conclusions
	Multiple Choice Questions
	References
Chapter 13: Suicide in HIV
	Introduction
	Epidemiology
	Predisposing Factors
	Protective Factors
	Psychodynamics and Cultural Context
	Prevention
	Multiple Choice Questions
	References
Chapter 14: HIV Syndemics
	The Evolution of HIV/AIDS and Syndemic Theory
	Syndemic Theory and Relevance to HIV/AIDS
		Syndemics: What Are the Components and How Do They Interact?
			Core Elements of Syndemics: Population
			Core Elements of Syndemics: Social Context
			Core Elements of Syndemics: Biological Interaction
		No Health Without Mental Health [46]: The Syndemogenic Effect of Psychiatric Illness
	Key Syndemics Associated with HIV
	A Syndemic Approach to HIV/AIDS Prevention: Future Directions
	Challenges and Limitations of the Syndemic Approach
	Conclusion
	References
Chapter 15: HIV in Specific Populations
	Introduction
		HIV and AIDS
	Children and Adolescents
		Epidemiology
		HIV Diagnostic Disclosure for Children
		Neurodevelopmental Considerations
		Health Behaviors
			Adherence
			Sex
		Facilitating Transition to Adult Care
	Women
		Epidemiology
		Illness Progression
		Treatment Issues
		Gender-Based Violence
		Conception and Pregnancy
		Menopause
	Black Americans
		Epidemiology
	Black Gay and Bisexual Men/Men Who Have Sex with Men (MSM)
		Black Women
		Medical Mistrust
		Justice Involved/Incarceration
		Religion and Spirituality
	Men Who Have Sex with Men (MSM)
		Risk Factors and Demographics
		Psychiatric Disorders in MSM Living with HIV
		“Party-and-Play” Drugs in the MSM Community
		Preventive Measures: Pre-exposure Prophylaxis (PrEP)
	Transgender Individuals
		Demographics and Introduction to HIV in the Transgender Population
		Mental Health in Transgender Persons
		Gender Dysphoria Treatment
		Hormone Therapy
		Hormone Therapy and ART
		Feminizing Surgeries
		Masculinizing Surgeries
		Psychotropic Medications and Hormone Therapy Considerations
		Testosterone and Mood Stability
		Mood Stabilizers That May Increase Testosterone Production
		Lithium and Spironolactone
		Anti-epileptic Mood Stabilizers and Estrogen
		Antipsychotics and Prolactin
	Older HIV-Positive MSM
	Conclusion
	Multiple Choice Questions
	References
Chapter 16: Principles of HIV Treatment
	Introduction
	HIV Life Cycle
	Considerations of Antiretrovirals
		Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)
			Tenofovir Disoproxil Fumarate
			Tenofovir Alafenamide
			Lamivudine and Emtricitabine
			Abacavir
			Zidovudine
		Non-nucleoside Reverse Transcriptase Inhibitors (NRTIs)
			Efavirenz
			Rilpivirine
			Doravirine
		Protease Inhibitors (PIs)
			Selected Protease Inhibitors
				Darunavir (DRV)
				Atazanavir (ATV)
			Pharmacokinetic Enhancers
				Ritonavir
				Cobicistat
		Integrase Strand Transfer Inhibitors (INSTIs)
			Raltegravir
			Elvitegravir
			Dolutegravir
			Bictegravir
		CCR5 Antagonists
		Post-attachment Inhibitors
		Fusion Inhibitors
	Treatment Recommendations
		Treatment Initiation
		First-Line Treatment Regimens
		Special Considerations
			Elderly Patients
			Substance Use Disorders
	Conclusion
	Questions
	References
Chapter 17: Antiretrovirals and Psychotropics: Drug Interactions and Complications
	Introduction
	Brief Review of Drug Interaction Principles and Metabolism
	HIV and Psychotropics
		Antidepressants
			Treating HIV-Related Symptoms
		Antipsychotics
			Mechanism of Action Review
			Treating HIV-Related Symptoms
			DDIs
			Treatment Course
		Mood Stabilizers
		Anxiolytics
		Hypnotics
		Medications for Substance-Related and Addictive Disorders
		Opioid Use Disorder
			Methadone
			Buprenorphine
			Naltrexone
		Alcohol Use Disorder
			Naltrexone
			Acamprosate
			Disulfiram
		Tobacco Use Disorder
			Nicotine
			Bupropion
			Varenicline
	Summary and General “Pearls”
	MCQs
	References
		Suggested Reading
Chapter 18: Treatment of Comorbid HIV/HCV
	Introduction
	HIV/HCV Co-infection and Psychiatry
	Management Challenges of HIV/HCV Co-infection
	Hepatitis C Viral Life Cycle
	Treatment of HCV Infection
	Drug Interactions with DAAs
	Primary Care Medication Use with DAAs
	Psychotropic Medication Use with DAAs
	Conclusions
	Questions
	References
Chapter 19: Integrated and Collaborative Care
	Introduction
	Consultation and Referral Model
	Co-located Model
	Patient-Centered Medical Home
	Collaborative Care Model
	Evidence for the Effectiveness of Collaborative Care
	Collaborative Care in HIV
	Key Components of Collaborative Care
	Roles and Workforce Training
	Diagnostic and Treatment Considerations
	Complexities of Providing Collaborative Care for HIV
	Challenges and Barriers to Collaborative Care
	Conclusions
	Questions
	References
Chapter 20: Palliative and End-of-Life Care in HIV
	Introduction
	Palliative Care in Racial, Ethnic, and Sexual Minorities
	Why ACP in the Days of Antiretroviral Medicine?
		Advance Directive
		Physician Order for Life Sustaining Treatment (POLST) Form
	Payment Issues in Palliative Care in the United States
	Funding Models in Palliative Care: The International Experience
	Hospice
	Medical-Assisted Dying
	Conclusions
	Multiple Choice Questions
	References
Chapter 21: Legal and Ethical Aspects of HIV Psychiatry
	Introduction
	HIV Testing
	Informed Consent
	Pre- and Post-test Counseling
	Opt-In/Opt-Out Testing
	Self-Testing
	Clinician-Initiated Testing in Pregnancy
	Reporting of Positive Results
	HIV Criminalization
	Efforts for Reform
	Bans on Blood Donation by HIV+ People
	Calls for Change
	Current Status of the Ban
	The Future of HIV and Blood Donation
	Conclusions
	Multiple Choice Questions
	References
Chapter 22: The COVID-19 Outbreak and the HIV Pandemic
	Introduction
	Perilous COVID-19 and HIV Comorbidity
	Stigma
	Isolation, Loss, and Struggle for Meaning
	Burden on Resources and Limited Access to Care
	Conclusions
	Multiple Choice Questions
	References
Index