Handbook of AIDS psychiatry PDF
Preview Handbook of AIDS psychiatry
Handbook of AIDS Psychiatry This page intentionally left blank Handbook of AIDS Psychiatry Mary Ann Cohen Harold W. Goforth Joseph Z. Lux Sharon M. Batista Sami Khalife Kelly L. Cozza Jocelyn Soffer 1 2010 1 OxfordUniversityPress,Inc.,publishesworksthatfurtherOxfordUniversity’s objectiveofexcellenceinresearch,scholarship,andeducation. Oxford NewYork Auckland CapeTown DaresSalaam HongKong Karachi KualaLumpur Madrid Melbourne MexicoCity Nairobi NewDelhi Shanghai Taipei Toronto Withofficesin Argentina Austria Brazil Chile CzechRepublic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore SouthKorea Switzerland Thailand Turkey Ukraine Vietnam Copyright(cid:1)2010byOxfordUniversityPress,Inc. PublishedbyOxfordUniversityPress,Inc. 198MadisonAvenue,NewYork,NewYork10016 www.oup.com OxfordisaregisteredtrademarkofOxfordUniversityPress,Inc. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedin aretrievalsystem,ortransmitted,inanyformorbyanymeans,electronic, mechanical,photocopying,recording,orotherwise,withouttheprior permissionofOxfordUniversityPress LibraryofCongressCataloging-in-PublicationData HandbookofAIDSpsychiatry/MaryAnnCohen...[etal.]. p. ; cm. Companionvol.to:ComprehensivetextbookofAIDSpsychiatry/editedby MaryAnnCohenandJackM.Gorman.2008. Includesbibliographicalreferences. ISBN-13:978-0-19-537257-1 ISBN-10:0-19-537257-3 1. AIDS(Disease)—Psychologicalaspects—Handbooks,manuals,etc. 2. HIVinfections—Psychologicalaspects—Handbooks,manuals,etc. 3. AIDS(Disease)—Patients—Mentalhealth—Handbooks,manuals,etc. 4. HIV-positivepersons—Mentalhealth—Handbooks,manuals,etc. I. Cohen,MaryAnn,1941– II. ComprehensivetextbookofAIDSpsychiatry. [DNLM:1. HIVInfections—psychology. 2. AcquiredImmunodeficiency Syndrome—complications. 3. AcquiredImmunodeficiencySyndrome—psychology. 4. HIVInfections—complications. 5. MentalDisorders—complications. 6. MentalDisorders—therapy. WC503.7H2362010] RC606.63H362010 616.9709206—dc22 2009030474 9 8 7 6 5 4 3 2 1 PrintedintheUnitedStatesofAmerica onacid-freepaper Acknowledgments We gratefully acknowledge all of the contributors to the Comprehensive TextbookofAIDSPsychiatry,whichservedasasourceforthisbook.This handbook is a companion book that is a short and practical guide for clinicians. For more in-depth information, we refer the reader to the Comprehensive Textbook. Some of the Textbook chapters were adapted, updated,andrewrittenfortheHandbookofAIDSPsychiatry.Thefollowing chapters, from Comprehensive Textbook of AIDS Psychiatry, MA Cohen and JM Gorman (eds.), New York: Oxford University Press, 2008, are acknowledgedwithappreciation: Bialer P, Hoffman RG, and Ditzell J. Substance Use Disorders—The SpecialRoleinHIVTransmission(pp.85–96). DickermanAL,BreitbartW,andChochinovHM.PalliativeandSpiritual CareofPersonswithHIVandAIDS(pp.417–437). DorellK,SofferJ,andGormanJM.PsychiatricInterventions(pp.379– 391). Ferrando SJ and Lyketsos CG. HIV-Associated Neurocognitive Disorders(pp.109–120). ForsteinM.YoungAdulthoodandSerodiscordantCouples(pp.341–355). GookinKandStoffD.OlderAgeandHIVInfection(pp.357–376). PaoMandWienerL.ChildhoodandAdolescencePsychiatry(pp.307– 339). RyanEandByrdD.NeuropsychologicalEvaluation(pp.73–84). Skapik J, Thompson A, Angelino A, and Treisman G. Psychotic DisordersandSevereMentalIllness(pp.131–140). This page intentionally left blank Preface TheHandbookofAIDSPsychiatryisapracticalguideforAIDSpsychiatrists and other mental health professionals as well as other clinicians who work with persons with HIV and AIDS. It is a companion book to the Comprehensive Textbook of AIDS Psychiatry (MA Cohen and JM Gorman,Eds.,OxfordUniversityPress,2008)fromwhichsomeofitschap- terswereadapted.TheHandbookoffersinsightsintothedynamicsofadher- encetoriskreductionandmedicalcareinpersonswithHIVandAIDS.Italso providesstrategiestoimproveadherenceusingabiopsychosocialapproach, as psychiatric factors both complicate and perpetuate the AIDS pandemic. WhenJoanBossert,oureditoratOxford,suggestedthatweconsiderwriting ahandbooksimilartoothersintheOxfordHandbookSeries,wewelcomed the idea because we realized that there was no short, practical guide that clinicianscouldconsulttohelpdiagnoseandtreatthepsychologicalproblems ofpersonswithHIVandAIDS.Sevenofthe72contributorstothetextbook tookonthetaskofdevelopingtheHandbookofAIDSPsychiatry. Whiletherearepsychiatricdisorderslinkeddirectlyandindirectlytorisk behaviors and HIV infection, persons with HIV or AIDS may have no psychiatric disorder or any disorder described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). In this handbook, we describe the psychiatric disorders most prevalent in persons with AIDS and most relevant for primary physicians, infectious disease specialists, and other caregivers. The impact of these disorders on health, adherence,behavior,andqualityoflifecanbeprofound. Psychiatric disorders may be the first and, at times, the only manifesta- tionofHIVinfection.EarlydiagnosisofcentralnervoussystemHIV-related viii PREFACE abnormalities can lead to timely introduction of treatment with antiretro- viral agents. In the literature, early neuropsychiatric disorders have been described, in addition to later manifestations of general psychopathology, dementia,psychosis,depression,andmania.Thesedisorderscanbeareac- tion to awareness of a diagnosis of HIV infection. Alternatively, psycho- pathology can be related to intrinsic involvement of the brain with HIV or opportunistic infections or cancers, such as toxoplasmosis, cryptococcosis, orlymphoma.Inaddition,antiretroviraltherapies,treatmentsforopportu- nistic infections and cancers, and treatment for comorbid hepatitis C virus infectionmayhavecentralnervoussystemsideeffects,includingpsychiatric symptoms. Multimorbid severe and complex medical conditions such as hepatic, renal, cardiac, neoplastic, endocrine, pulmonary, gastrointestinal, andotherillnessesfurthercomplicateHIV andAIDSbecauseofassociated psychiatricmanifestations. PsychiatricdisordersplayaroleinthetransmissionofHIV,andpsychia- tricfactorsalsoplayamajorroleinthesufferingenduredbypatients,their partners, families, and caregivers. Psychiatric disorders such as depression, addiction,mania,posttraumaticstressdisorder,andcognitivedisorderscan worsenadherence,morbidity,prognosisandmortality.Ifpsychiatricdisor- ders go untreated, patients with HIV and AIDS have difficulty attending appointmentsandadheringtothecomplexmedicaltreatmentsinvolvedwith care. Infectious disease specialists, primary physicians, nurses, social workers,casemanagers,otherhealthcareworkers,andphysiciansinevery specialty may find themselves frustrated that patients are not adhering to medical care and are getting ill in the same ways that patients did in the beginning of the pandemic, when few or no treatments were available and mortalitywashigh.NowthatperinatalHIVtransmissioncanbeprevented byantiretroviralprotocols,obstetriciansmayfindthemselvesstymiedwhen pregnant women do not adhere to prenatal care and to antiretroviral treatment. Persons with severe mental illness and substance use disorders have a higher prevalence of HIV infection than that in the general population. PersonswithHIVinfection,severementalillness,andsubstanceusedisorder mayalsolackaccesstomedicalcareandantiretroviraltherapy.Thecourseof HIV-relatedillnessisverydifferentinpersonswithseverementalillnesswho lack access to adequate medical care: they have a course similar to that of persons in the early years of the pandemic or of persons living in resource- limitedareasoftheUnitedStatesortherestoftheworld.Thislackofaccess tocarehasledtoamajordisparityintheAIDSpandemic. We describe the gaps in care and the entirely different HIV pandemics seen in persons with treated and untreated psychiatric disorders, and we provide strategies to close some of these gaps. We also address the chronic illnessthatAIDShasbecomeformostpersonswithaccesstoantiretroviral Preface ix therapy.Forexample,weincludeasectiononsmokingcessationmodalities, sincemorepeoplewithHIVwhoaretreatedwithantiretroviraltherapywill dieoflungcancer,heartdisease,emphysema,orcomplicationsofsubstance usedisordersthanwilldieofAIDS-relatedillness.Wealsocoverthecareand treatmentofpersonswholackaccesstocareorarenonadherenttocare.The Handbook has protocols for the evaluation and treatment of AIDS-related psychiatricdisorders,aswellasAIDSpalliativepsychiatry. Because there is an ample body of evidence that psychiatric care can decreasetransmission,diminishsuffering,improveadherence,anddecrease morbidityandmortality,wehaveaimedtoprovideinsightintotheinterface betweenthepsychiatric,medical,andsocialdimensionsofHIVandAIDSin thechaptersofthisbook.WehopethattheHandbookofAIDSPsychiatry, as a practical guide to AIDS psychiatry, will help clinicians in a variety of clinicalsettings. WeareparticularlygratefultoJackM.Gorman,co-editor,andallofthe contributors to the Comprehensive Textbook of AIDS Psychiatry for the outstandingworkthatprovideduswiththebasisforsomeofourchaptersin this Handbook; to our editors and associate editors at Oxford University Press,JoanBossert,AbbyGross,NancyWolitzer,andAaronVanDorn;and to our copy editor Jerri Hurlbutt, who made this work possible. We are especiallygratefultoourfamiliesandfriendsfortheirpatienceandsupport. Wededicatethisbooktothecourageousmen,women,andchildrenwith HIVandAIDS,totheirfamiliesandtotheirlovedones.Wealsodedicatethe booktothe compassionateandcaringHIVclinicianswhoworkwithusto providecareandsupportforpersonswithHIVandAIDS. MaryAnnCohen HaroldW.Goforth JosephZ.Lux SharonM.Batista SamiKhalife KellyL.Cozza JocelynSoffer
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