A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

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A Guide to Primary Care of People with HIV/AIDS Chapter 13: Management of Substance Abuse REFERENCES American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association Press; 1994. American Society of Addiction Medicine. Screening Instruments. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine; 1998:1283-1286. Chesney MA, Koblin BA, Barresi PJ, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE Study. Am J Public Health. 2003;93:933-938. Principles of Drug Addiction Treatment: A Research-Based Guide. Bethesda, MD: National Institute on Drug Abuse; 1999. NIH Publication 99-4180. Available at http:// www.drugabuse.gov/PubCat/PubsIndex.html Accessed 1/04. Principles of HIV Prevention in Drug-Using Populations: A Research-Based Guide. Bethesda, MD: National Institute on Drug Abuse; 2002. NIH publication 02-4733. Available at http://www.drugabuse.gov/ PubCat/PubsIndex.html Accessed 1/04. Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. 1996;156:2287-93. Gourevitch MN, Friedland GH. Interactions between methadone and medications used to treat HIV infection: a review. Mt. Sinai J Med. 2000;67:429-436. Hyman SE, Malenka RC. Addiction and the brain: the neurobiology of compulsion and its persistence [Review]. Nat Rev Neurosci. 2001;2:695-703. 13 Johnson RE, Chutuape MA, Strain EC, Walsh SL, Stitzer ML, Bigelow GE. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. New Engl J Med. 2000;343:1290-1697. Leshner, AL. Addiction is a brain disease, and it matters. Science. 1997;278:45-47. McLellan AT. Have we evaluated addiction treatment correctly? Implications from a chronic care perspective. Addiction. 2002;97: 249-252. O’Brien CP. A range of research-based pharmacotherapies for addiction. Science. 1997;278:66-70. 114 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
A Guide to Primary Care of People with HIV/AIDS Chapter 14: Mental Health Disorders Chapter 14: Mental Health Disorders Linda Frank, PhD, MSN, ACRN Glenn J. Treisman, MD, PhD Niccolo D. Della Penna, MD OVERVIEW DISORDERS OF ATTENTION OR COGNITION PERSONALITY DISORDERS MOOD DISORDERS ANXIETY DISORDERS SUGGESTED RESOURCES REFERENCES OVERVIEW Why is it important to address mental health disorders in persons living with HIV? HIV infection increases the risk of developing psychiatric disorders, including depression, mania, psychosis, and substance abuse (Treisman, 1999). For patients with preexisting mental illness, a diagnosis of HIV can significantly impact their ability to cope with HIV disease, adhere to treatment regimens, and take advantage of support networks and care systems, and can result in deterioration in their quality of life. Individuals with previous histories of mood, cognitive, or anxiety disorders may exhibit a reemergence or exacerbation of symptoms. As persons with HIV/AIDS live longer and the focus of care shifts from acute to chronic, the long-term psychological impact of HIV disease becomes more apparent. What common HIV-related medical conditions have psychiatric symptoms? It is essential for primary care providers to be aware of the need for a comprehensive evaluation of psychiatric symptoms in persons with HIV disease. Many psychiatric symptoms can indicate an underlying opportunistic disease or other condition (see Table 14-1). What are the most common mistakes made in mental health management of HIV-infected patients? Primary care providers commonly 1) under-diagnose depression, 2) under-dose antidepressant medications, 3) neglect substance use management and treatment, 4) stigmatize patients with psychiatric disorders, and 5) assume that psychotherapy implies a lengthy and detailed conversation. Table 14-1. HIV-Related Conditions That Can Present With Psychiatric Symptoms Type of problem Opportunistic brain infections Opportunistic malignancies Metabolic complications Drug toxicity Substance abuse complications Condition Toxoplasmosis, cryptococcal meningitis, cytomegalovirus infection, tuberculosis, progressive multifocal leukoencephalopathy, neurosyphilis Lymphoma, Kaposi sarcoma Fever, anemia, blood infections, hypoxia, hypotestosteronism Corticosteroids, alpha-interferon, efavirenz (EFV) Recreational drugs (cocaine, alcohol, methamphetamine, hallucinogens, nitrate inhalant, opiates) Prescribed drugs (benzodiazepines, opiates, psychostimulants) What conditions warrant psychiatric consultation? Providers should obtain psychiatric consultation in 1) major depression refractory to medication trials, 2) bipolar disorder, 3) schizophrenia, and 4) suicidal or homicidal thoughts. DISORDERS OF ATTENTION OR COGNITION What are the characteristics of delirium in patients with HIV infection? Delirium, which is a state of global derangement of cerebral function, occurs more frequently in medically 14 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau 115
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