HIV Psychiatry: A Practical Guide for Clinicians

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This book is a practical guide in understanding how to prevent HIV transmission, to recognize risk behaviors, and to add something else to their repertoires. It aims to empower clinicians and provide 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 continue to persist throughout every area of the world despite the magnitude of the progress that has transformed the illness from a rapidly fatal to chronic illness that is no longer life-limiting. 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. This practical guide provides state-of-the-art understanding of not only prevention but also a way to recognize risk behaviors, psychiatric symptoms, and psychiatric illnesses that will demystify and decode the sometimes enigmatic and frustrating reasons for nonadherence with diagnostic procedures and life-saving treatments and care. All behaviors and pathology are covered as well as the resources and treatments available. The goal of this text is to refresh knowledge on the current state of psychiatric illness management among people living with HIV, to provide a concise volume on the psychiatric aspects of HIV prevention and treatment that substantially impact the overall care of the patient, and to help understand the psychiatric catalysts of the pandemic

Written by experts in the field, HIV Psychiatry: A Practical Guide for Clinicians provides enduring guidance to medical and other professionals caring for complicated clinical patients as they face ongoing challenges in working with persons with HIV and AIDS.


Author(s): James A. Bourgeois, Mary Ann Adler Cohen, Getrude Makurumidze
Publisher: Springer
Year: 2021

Language: English
Pages: 607
City: Cham

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