HIV Psychiatry: A Practical Guide for Clinicians

591 Pages·2021·8.084 MB·English

by  James A. Bourgeois, Mary Ann Adler Cohen, Getrude Makurumidze

HIV
Psychiatry
A Practical Guide
for Clinicians
James A. Bourgeois
Mary Ann Adler Cohen
Getrude Makurumidze
Editors
123
HIV Psychiatry
James A. Bourgeois • Mary Ann Adler
Cohen • Getrude Makurumidze
Editors
HIV Psychiatry
A Practical Guide for Clinicians
Editors
James A. Bourgeois Mary Ann Adler Cohen
Baylor Scott & White Health Icahn School of Medicine at Mount Sinai
Texas A&M University New York, NY
Temple, TX USA
USA
Getrude Makurumidze
School of Medicine, Georgetown
University, District of Columbia
Washington, DC
USA
ISBN 978-3-030-80664-4 ISBN 978-3-030-80665-1 (eBook)
https://doi.org/10.1007/978-3-030-80665-1
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Foreword
Effective HIV care remains challenging and complex, despite great advances in the
treatments that have reduced side effects and allow survival durations approaching
those of uninfected persons. HIV infection must be seen as much more than an iso-
lated illness. Rather, it exists in a social context, where issues as seemingly separate
as stigma, isolation, substance use, as well as an array of comorbid illnesses may
contribute to healthcare disparities and compromise treatment outcomes. Persons
with HIV often experience mental health stressors or co-incident psychiatric disor-
ders, and care systems and clinicians must understand and address these issues to
optimize the full health of their patients. Fortunately, they now have an ally in a new
book, HIV Psychiatry: A Practical Guide.
Dr. Mary Ann Cohen, one of the world’s leading experts in HIV psychiatry, and
her colleague, Dr. James Bourgeois, have assembled an impressive group of authors
to provide a wide-ranging review of the multifaceted interactions among HIV infec-
tion, its social setting, and the common mental health comorbidities. They highlight
the multidirectional nature of these relationships, how HIV infection can lead to or
exacerbate psychosocial conditions, and how those conditions may compromise the
medical management of HIV itself. Each chapter aims to provide truly practical
advice for busy clinicians who may feel untrained and poorly supported in these
crucial aspects of high-quality, comprehensive care.
The Practical Guide brings our attention to a wide range of topics. Some are, of
course, expected, including HIV and psychiatric co-morbid illnesses such as anxi-
ety, depressive, and bipolar disorders, as well as suicide risk. While some HIV care
settings have created models of integrated care that bring together teams of medical,
mental health, and psychosocial experts, many HIV clinicians must provide a wide
range of care themselves. The Practical Guide addresses both ends of this care spec-
trum by reviewing models of care to help bring teams together, while also offering
direct advice on managing the full array of medical and mental health conditions
seen commonly in busy practices. The book includes reviews of screening tools to
better identify co-morbid psychiatric illnesses, particularly those tools that are prac-
tical in application and available without charge. One of the most admirable direc-
tions taken by the editors and authors of this new book is their attention to the social
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vi Foreword
setting of HIV infection, including stigma, discrimination, healthcare access barri-
ers and disparities, and how these must be understood to optimize care outcomes.
The book identifies these complex medical and societal interactions as syndemics,
an important approach to better address these challenges.
HIV Psychiatry: A Practical Guide is also current with today’s many changes.
The review of HIV and HCV incorporates newly developed curative HCV medica-
tions, and another chapter reviews the still-evolving story of HIV and COVID-19.
In a useful chapter on legal and ethical aspects of HIV care, the topic of the unfor-
tunate but still-in-place and actively debated regulations preventing gay men from
donating blood is considered.
This new book provides a unique benefit for effective, comprehensive, and com-
passionate HIV care. Its editors and authors are to be congratulated. This is a timely
and important contribution.
Emeritus Professor of Medicine Paul Volberding
University of California, San Francisco
San Francisco, CA, USA
Preface
Many HIV physicians who take care of persons with HIV and AIDS are infectious
disease specialists who, over the past 40 years, have helped to revolutionize treat-
ments and transform HIV and AIDS into a chronic manageable illness. Now, HIV
physicians are ensuring that their patients stay well, get the best HIV care, and also
get the care they need for other multimorbid illness. They know well that HIV can
be prevented and make use of the remarkable resources that enable their patients to
prevent transmission to others. These include “U = U” – Undetectable = Untransmittable,
“PEP” – Post-Exposure Prophylaxis, and “PrEP” – Pre-Exposure Prophylaxis.
However, most HIV physicians, because of their superb and competent care of per-
sons with HIV, do not see persons who are not infected with HIV.
It is up to all the rest of us to be sure that we are able to make use of resources
for prevention.
It is the pediatrician who cares for adolescents, the geriatrician who sees older
adults, the internist, primary care physician, neurologist, obstetrician-gynecologist,
surgeon, emergency room physician, general psychiatrist, dentist, as well as nurses,
physician assistants, social workers, psychologists, and addiction counselors who
see patients long before they become infected with HIV.
All clinicians need to know that even after a potential inadvertent or coerced
exposure to HIV that HIV infection can be protected with PEP. All clinicians need
to be able to recognize and risk behaviors and make recommendations to help with
changes just as they routinely recommend the use of sunscreen for skin cancer pre-
vention, exercise and healthful eating for general health and well-being, smoking
cessation for prevention of lung disease and oropharyngeal cancers and other vitally
important preventive measures such as physicals, dental care, obstetrical care, vac-
cinations, and screening for breast, colon, and prostate cancer.
In this practical guide for clinicians, we hope to empower clinicians to under-
stand how to prevent HIV transmission, to recognize risk behaviors, and to add
something else to their repertoires. We hope to give all clinicians a sense of security
and competence with the recognition and understanding of some of the psychiatric
illnesses that complicate and perpetuate the HIV pandemic that continues to persist
throughout every area of the world despite the magnitude of the progress that has
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viii Preface
transformed the illness from a rapidly fatal to chronic illness that is no longer life
limiting. In 2018, there were still a total of 37.9 million persons living with HIV
throughout the world, 1.7 million newly infected, and 770,000 deaths.
There were 17 million orphans left behind by AIDS.
Missing in most of the literature on HIV is the subtle, and sometimes not so
subtle, contribution of psychiatric symptoms, psychiatric illness, and risk behaviors
that drive the pandemic and serve as catalysts for new infections.
In this practical guide, we provide you with the state-of-the-art understanding of
not only prevention but also a way to recognize risk behaviors, psychiatric symp-
toms, and psychiatric illnesses that will demystify and decode for you the some-
times enigmatic and frustrating reasons for nonadherence with diagnostic procedures
and life-saving treatments and care.
We cover all of the behaviors and pathology as well as the resources and treat-
ments available.
Intimately related to the psychiatric illness, and potentiating the overall suffering
of early HIV patients, is the social stigma experienced by HIV patients. The ele-
ments of such social stigma include HIV itself, psychosocial and psychiatric vulner-
ability, and discrimination of a more “systemic” nature, e.g., inadequacy of
optimized medical care, patients being uninsured or underinsured for healthcare,
and other areas of poor social support for the management of a chronic and severe
illness. Regrettably, stigma continues to apply to patients with other psychiatric ill-
nesses, not necessarily those associated with HIV.
From prevention to exposure, transmission, infection, and course of illness, the
human immunodeficiency virus (HIV) and acquired immune deficiency syndrome
(AIDS) are inextricably related to risk behaviors and mental health. HIV stigma and
fear further complicate the HIV pandemic. Comprehensive and collaborative care
play a vital role in the prevention of suffering and adherence to care. An understand-
ing of the psychiatric and psychosocial aspects of the HIV pandemic is key to the
prevention of HIV transmission and the prevention of suffering in persons with HIV
and AIDS. Nearly four decades later, some of the principles we have learned may be
applicable to the COVID-19 pandemic. Of particular note is the disparate impact of
pandemics on populations and on healthcare. The magnification of racism in society
and healthcare disparities is once again apparent. While the modes of transmission,
the immediacy and terror invoked by droplet infection, and specific vulnerabilities
make these very different pandemics, the clear need for changes in both society and
healthcare are similar.
As the world struggles to come to grips with yet another international pandemic
with COVID-19 (which disproportionately impacts socially marginalized and stig-
matized populations, as has been the case with HIV), medical professionals and
other advocates must come up with strategies to accommodate to the realities of the
COVID-19 pandemic, while continuing the yet unfinished work in managing the
multitudinous complications and intricacies of HIV disease. As one pandemic has
passed the initial, acute phase to be transformed to a complex chronic illness,
another has supplanted it. The editors hope that this guidebook, written by many
authors with the challenges and honors of managing the COVID-19 pandemic,
Preface ix
gives enduring guidance to medical and other professionals caring for complicated
clinical patients.
An understanding of the role of psychiatric aspects of HIV and AIDS is crucial
for both prevention of HIV transmission and for the care of persons with HIV. It is
in this spirit that we have written this book. All editors have been closely involved
in HIV psychiatry. Our goal is to produce a book for three audiences. For the psy-
chiatrist who may not specialize in HIV psychiatry per se, there is a need for a
refresher on the current state of psychiatric illness management among people liv-
ing with HIV. For primary care physicians, specialists, and subspecialists, there is a
need for a concise volume on the psychiatric aspects of HIV prevention and treat-
ment that substantially impacts the overall care of the patient. Finally, for those
health and mental health professionals from clinical psychology, nursing, physician
assistant, social work, and for clinicians and professionals in other disciplines, there
is a need for similar understanding of psychiatric catalysts of the pandemic.
HIV began as a dramatic, unexpected epidemic. Due to the efforts of many, it has
been transformed into a generally manageable chronic illness, albeit with its persis-
tent specific complications. From the beginning of the pandemic to the present,
psychiatric multimorbidity remains an important element in prevention of HIV and
the illness experience and care for persons infected with and affected by HIV. The
editors hope that this volume provides useful guidance for our health-profession
colleagues as they face ongoing challenges in working with persons with HIV
and AIDS.
Temple, TX, USA James A. Bourgeois
New York, NY, USA Mary Ann Adler Cohen
Contents
1 The Definition and Scope of HIV Psychiatry: How to Provide
Compassionate Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Mary Ann Adler Cohen, Jonathan Artz, Hameed Azeb Shahul,
Caitlin Gonsolin, Ripal Shah, Dennis Dacarett-Galeano,
Luis F. Pereira, and Kelly L. Cozza
2 HIV Testing and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Mark V. Bradley, Luis F. Pereira, and Mary Ann Adler Cohen
3 HIV Stigma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Getrude Makurumidze, Jae Lee Ross, Ripal Shah,
Dennis Dacarett-Galeano, Jonathan Artz,
and Mary Ann Adler Cohen
4 Consultation, Assessment, and Evaluation . . . . . . . . . . . . . . . . . . . . . . 67
Mary Ann Adler Cohen, Danielle Wilkin, Mark V. Bradley,
Luis F. Pereira, Kelly L. Cozza, and Christina M. Patel
5 Screening for Psychiatric Disorders in HIV Care . . . . . . . . . . . . . . . . 93
Francine Cournos and Karen M. McKinnon
6 Depressive Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Silvia Ferrari, Jordi Blanch, Shadi Lavasani, Steven C. Beall,
Steven J. Gibson, Federica Maria Magarini, and Silvia Alboni
7 Trauma and Stressor-Associated Disorders . . . . . . . . . . . . . . . . . . . . . 135
Mark V. Bradley, Suad Kapetanovic, Thomas (Ryan) O’Leary,
and Maureen E. Lyon
8 Bipolar Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Antoine Douaihy, Grace Kang, and Tianyi Zhang
9 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Jordi Blanch, Tianyi Zhang, Steven C. Beall, Steven J. Gibson,
and Grace Kang
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