Description
This journal article provides a comprehensive overview of the psychiatric care required for patients across the HIV disease spectrum, authored by Dr. Karl Goodwin, a professor and director of clinical research at Cedars-Sinai Medical Center and UCLA. It outlines the psychiatrist's critical role in identifying high-risk behaviors, offering HIV antibody testing, and providing follow-up counseling. The document details the specific presentation and management of psychiatric disorders in this population, including adjustment, anxiety, and depressive spectrum disorders that frequently arise around serostatus notification and initial symptoms. It extensively covers HIV-associated neurocognitive disorders like mild neurocognitive disorder and HIV-associated dementia, emphasizing the need for thorough differential diagnosis to rule out opportunistic infections and medication toxicities. The article also addresses psychosis in HIV, discussing its various etiologies and the careful selection of antipsychotic medications. Aimed at practicing psychiatrists, the resource synthesizes clinical guidelines and evidence to support the diagnosis and tailored treatment of these conditions, integrating considerations for psychopharmacotherapy, drug interactions, and the neuroinflammatory aspects of HIV. It serves as essential university-level material for mental health professionals and medical students specializing in psychosomatic medicine or consultation-liaison psychiatry. Download this in-depth review to enhance your clinical approach to neuropsychiatric complications in HIV.
What's inside
Karl Goodkin, M.D., Ph.D. Psychiatric Aspects of HIV Spectrum Disease Abstract: The HIV/AIDS epidemic is not considered “under control” in the United States. An unacceptably high inci- dent case rate has been sustained over the past decade. CDC now advocates for routine HIV antibody testing to be of- fered in all health care settings. The psychiatrist can play an important role in identifying HIV high risk behaviors, in presenting the option for HIV antibody testing, and in providing follow-up with counseling. The high risk for HIV infection among the severely mentally ill also directly involves the psychiatrist today in HIV/AIDS care. Anxiety, de- pressive spectrum, neurocognitive, and psychotic disorders present with symptom profiles and in settings that are spe- cific to HIV infection and require the need for individually tailored psychiatric care. Guidelines for the psychiatrist treating HIV infected patients are available. It is incumbent upon the practicing psychiatrist to maintain familiarity with these guidelines and offer the capacity to treat the psychiatric disorders that occur in this patient population. The number of persons with HIV-1 infection in the United States has continued to rise, consistently increasing at an estimated 56,000 per year for the past decade. Thus, the HIV/AIDS epidemic cannot be considered “under control” at this time. Since the introduction of highly active antiretroviral ther- apy (HAART) combination regimens in late 1995, great gains have been made in decreasing the mor- bidity and mortality of the disease. Nevertheless, replication of HIV-1 is known to continue at a very low level despite “nondetectable” levels of HIV-1 RNA in the peripheral blood (1). It has also been shown that HIV-1 replicates at a relatively higher level in the CSF than in the plasma in patients with a diagnosis of HIV-associated dementia (HAD) as opposed to those with no neurological disease (2). These results are supported by other studies show- ing that independent HIV-1 replication in the CNS predominates in advanced disease and is con- tributed to by CNS-derived virus. Hence, the CNS has been designated as a “reservoir” maintained by HIV-1 in the face of currently effective systemic treatment. As a result, increasing concern has been directed to the neuropsychiatric outcomes of HIV-1 infection: HIV-1-associated asymptomatic neurocognitive impairment, mild neurocognitive disorder (MND) [formerly minor cognitive-motor disorder (MCMD) (3)], and HAD [formerly AIDS dementia complex (ADC)] (4). After a brief back- ground on HIV/AIDS, this article will focus on the information psychiatrists need to know today for 1) the evaluation of risk for HIV-1 infection, 2) HIV-1 antibody testing and related counseling, 3) the secondary prevention of HIV-1 disease pro- gression, and 4) the diagnosis and treatment of neu- ropsychiatric disorders in HIV-1 infected persons. (Hereafter, I will refer to “HIV-1” as “HIV” for general usage, as the prevalence of HIV-2 is very low in the United States.) BRIEF BACKGROUND ON HIV/AIDS The Centers for Disease Control and Prevention (CDC) began tracking cases of AIDS in 1981. Hu- man T cell lymphotropic virus type III (HTLV-III, later to be called “HIV”) was isolated in 1983 (5). The dementia associated with HIV infection was first characterized as caused by HIV itself in 1986 (6, 7). In the revised CDC case definition of AIDS of 1987, “HIV encephalopathy” was included as an AIDS-defining event (8). The CDC staging system and the AIDS case definition were both revised in 1993 (9). The CDC staging system was revised to be defined by three clinical stages (A asymptom- atic, B early symptomatic, and C late symp- tomatic/AIDS). In addition, immunological dis- CME Disclosure Karl Goodkin, M.D., Ph.D., Professor and Director of Clinical Research, Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center and Professor in Residence, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA. Advisor: Advanced Immunit; Speaker List: Merck; Grant Applicant: Janssen, Amgen Supported in part by NIMH grants MH58532 and MH75658. Address correspondence to Karl Goodkin, M.D., Ph.D., Department of Psychiatry and Behavioral Sciences, Cedars-Sinai Health System, 8730 Alden Dr., E-105, Los Angeles, CA 90048; e-mail: Karl.Goodkin@cshs.org. focus.psychiatryonline.org FOCUS Summer 2009, Vol. VII, No. 3 303 C L I N I C A L S Y N T H E S I S ease staging was added to this staging …
An extract of the text. Open the file below to read the full document.