HIV and Psychiatry Training and Resource Manual 2nd Edition by Kenneth Citron, Marie JosA Brouillette, Alexandra Beckett ISBN 0521009189 9780521009188

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ISBN 10: 0521009189 
ISBN 13: 9780521009188
Author: Kenneth Citron, Marie JosA Brouillette, Alexandra Beckett

HIV and Psychiatry Training and Resource Manual 2nd Table of contents:

1 Medical overview
Introduction
What is the epidemiology of HIV infection?
World
USA
How is HIV transmitted?
Sexual
Injection drug use
Maternal?fetal
Other considerations
What is the pathogenesis of HIV infection?
How is a diagnosis of HIV infection made, and how is HIV infection classified?
What are the clinical manifestations of HIV infection?
Primary HIV infection
Latency period
Oral and skin manifestations
Pulmonary manifestations
Gastrointestinal manifestations and multi-organ system disease
Neurocognitive and neurologic manifestations
What is involved in the initial evaluation of a patient with HIV disease?
History
Physical examination
Laboratory studies
How is HIV infection managed?
Antiretroviral therapy
Principles of use
Adherence
Resistance
Modification of regimen
Long-term toxicities
New therapeutic modalities
Opportunistic infection prophylaxis
Principles of use
Discontinuation of prophylaxis
Conclusion
Suggested reading
Web Sites
2 Cognitive disorders in people living with HIV disease
Introduction
What causes the cognitive dysfunction associated with HIV infection?
What nomenclature is used to describe the neurobehavioral disorders that occur in HIV infection?
What is the prevalence of HADC and MCMD?
What are the characteristics of HACM?
What are the characteristics of HIV-associated minor cognitive motor disorder (MCMD)?
What is the course of illness?
What is the morbidity associated with HIV-related neurocognitive impairment?
What is the relationship between cognitive complaints and depression?
What is the treatment approach when patients have symptoms of depression and MCMD?
When should a psychiatrist consider neuropsychological testing?
Epilogue
What are the characteristics of HIV-associated dementia complex (HADC)?
What are the risk factors for HADC?
Which elements in this history are important in establishing the diagnosis?
What is the differential diagnosis and how can the physician narrow it?
What other investigations are necessary to establish a diagnosis?
Could the patient’s symptoms be caused by major depression?
Could the symptoms be caused by the substances that the patient is using?
What mental status screening and assessment tools should be used?
What other staging system can be used to describe the cognitive changes in HIV disease?
Are there specific treatments for HACM?
What can be done for the fatigue and apathy?
Epilogue
What impact does HADC have on behavior?
How should behavioral symptoms associated with HADC be treated?
Are there nonpharmacological interventions that should be considered in the management of HADC?
What is the prognosis for a person presenting with HADC?
Conclusion
References
3 General principles of pharmacotherapy for the patient with HIV infection
Introduction
What is the main mechanism responsible for interactions between antiretrovirals and …
How are antiretrovirals metabolized and how can they influence the bioavailability of psychotropic m
What are the clinical implications of these pharmacokinetic interactions?
What medications used in HIV care (other than antiretrovirals) can have an impact on the metabolism
How can psychotropic medications have an impact on the bioavailability of antiretroviral agents and
Are there significant interactions between antiretrovirals and alternative products (herbal medicine
How can antiretrovirals interact with opiate medications?
Are there significant interactions between antiretrovirals and recreationally used/abused substances
What types of neuropsychiatric side effects have been associated with the use of antiretrovirals and
How does one choose a psychopharmacological agent for a patient with HIV infection?
Major depressive disorders
Bipolar disorders
Anxiety disorders
Psychotic disorders
Sleep disorders
What precautions should a clinician take in order to safely prescribe medications in an HIV-infected
Conclusion
References
Suggested Reading
4 Mood disorders and psychosis in HIV
Introduction
What is the differential diagnosis?
What are the risk factors for the development of depression and suicidality?
What impact does depression have on disease progression?
What are the risks associated with untreated depression?
What is the nonpharmacological management of depressive disorders in people with HIV?
What is the differential diagnosis?
What is the relationship between depression and cognitive difficulties in HIV infection?
Which medications for HIV are associated with depression?
Which opportunistic infections may induce or mimic depression?
What is the initial evaluation for depression?
What are some considerations in prescribing an antidepressant for people with HIV?
Medication side effects
Medication interactions
Which antidepressants should be used in this population?
What is the differential diagnosis of mania in HIV?
Would the diagnostic considerations have been different if the patient had presented with psychosis
What is the initial evaluation for mania and psychosis in HIV infection?
How do you treat mania and psychosis in HIV infection?
Mood stabilizers
Antipsychotics
Benzodiazepines
Other
Conclusion
References
Suggested reading
5 Suicidal behavior and HIV infection
Introduction
How should clinicians assess deliberate self-harm in a person with HIV infection?
Identify circumstances leading to act
Determine degree of suicide intent
Assess current risk of suicide or further self-harm
Do mental status examination and complete history
Identify need for further mental health intervention
What are the factors associated with an increased risk of deliberate self-harm in people with HIV in
Should Robert be seen urgently and detained involuntarily under local mental health legislation?
What are the different aspects of social support that should be explored as part of an assessment fo
What can psychiatrists do when asked to assist with suicide?
What else could the psychiatrist have done to prevent Kevin’s suicide?
What is the role of the psychiatrist in the care of partner and other relatives?
Who cares for the caregivers?
Conclusion
Suggested reading
6 Anxiety disorders and HIV disease
Introduction
What are the benefits to a patient of distinguishing accurately between normal anxiety and an anxiet
What factors should be considered in psychotherapy for patients with anxiety disorder?
Can antiretroviral or other medications contribute to anxiety?
Can underlying medical disorders or HIV itself cause anxiety?
What factors must be considered in diagnosing anxiety disorders?
What is the pharmacological management of anxiety disorders in the context of HIV infection?
Recommended treatment strategy
Conclusion
References
7 General issues in hospital HIV psychiatry
Introduction
What is the psychiatrist’s role in this case?
What is Mark’s diagnosis?
What is delirium?
What is the differential etiology of the delirium?
What is the treatment for delirium?
How are sleep problems addressed in the hospital setting?
How should Mark’s pain be managed?
Conclusion
References
8 HIV and people with serious and persistent mental illness
Introduction
How is an HIV risk assessment conducted?
What are the special issues involved in HIV testing of people with serious and persistent mental ill
How often should people with serious and persistent mental illness be tested for HIV?
How are people with serious and persistent mental illness likely to react to a diagnosis of HIV infe
What are the most common risks for HIV infection in psychiatric patients?
Sexual activity
Substance use
Environmental and social factors
How do psychiatric disorders contribute to HIV risk-taking?
What are the special issues involved in the follow-up of people with HIV who also have serious and p
What are the determinants of HIV risk reduction among psychiatric patients?
How can psychiatrists help patients reduce their risk of transmitting or acquiring HIV?
What is the role of individual counseling in helping patients change their risk behaviors?
Conclusion
References
9 Psychotherapy
Introduction
What types of psychotherapy are useful in the treatment of people with HIV?
What is the therapist’s responsibility in pointing out potentially dangerous behaviors to patients?
What issues impact on a person’s ability to adhere to safer sex practices?
What approach should the therapist take when the patient engages in high-risk behaviors?
What is the role of CBT in the treatment of people with HIV infection?
What are the pre- and posttest counseling guidelines for HIV?
What types of intervention are helpful soon after HIV is diagnosed?
What is the role of denial in living with HIV infection?
What potential roles does psychodynamic psychotherapy have in treating persons with HIV?
What are some of the expected transference issues which might emerge in a dynamic therapy with someo
What are some of the expected countertransference issues that might emerge in a dynamic therapy?
What are the issues associated with termination in this population?
How does ambivalence relate to living with HIV infection?
What issues figure prominently in the psychotherapy of long-term survivors with HIV infection?
What is the role of interpersonal psychotherapy in treating people with HIV infection?
What issues may arise in psychotherapy with regard to return to work?
What issues does the patient face in dealing with long-term side effects of HIV treatment?
What issues should the therapist address in the face of a patient deciding to terminate treatment wi
What are the spiritual issues for someone faced with HIV disease?
What concerns arise for the psychiatrist in the face of impending death?
What are the implications for psychotherapy when it moves to the person’s home?
Conclusion
References
Suggested reading
10 HIV and substance use disorders
Introduction
What is a harm reduction strategy?
How important is adequate dosage of methadone?
How does antiretroviral therapy affect methadone metabolism?
Does antiretroviral therapy affect the metabolism of recreationally used drugs?
Can the presence of psychiatric comorbidity affect the patient’s ability to adhere to treatment?
What are the different models of care for people with a dual or triple diagnosis?
In a patient not already involved with the healthcare system (i.e., methadone maintenance), how woul
What is the Stages of Change model?
To what extent does alcohol abuse influence adherence to treatment?
Can alcohol abuse affect sexual behaviour?
What is the Information?Motivation?Behavioral (IBM) skills model?
Information
Motivation
Behavioral skills
Conclusion
References
Suggested reading
11 Psychiatric issues in pediatric HIV/AIDS
Introduction
What neurocognitive disorders are seen in young children with HIV?
How do neurocognitive deficits present in younger children?
What is the standard evaluation of a child suspected of having neurocognitive impairment secondary t
What are the treatment options for neurocognitive disorders in HIV-infected children?
What other treatments are effective for managing HACM?
How common is depression among HIV-infected children and adolescents?
How do depressed HIV-seropositive children and adolescents typically present?
What should be included in the evaluation of an HIV-seropositive child or adolescent with depression
What is the differential diagnosis of depression in children and adolescents with HIV/AIDS?
What psychological themes underlie the presentation of pain in younger individuals?
What principles should be followed when prescribing psychotropic medications for depressed HIV-infec
What types of psychotherapy and systemic interventions are useful for depressed children and adolesc
How does age affect a child’s reaction to issues of death and dying?
How can mental health professionals help an HIV-seropositive child cope with the death of a parent?
What adherence issues are seen among HIV-positive children and adolescents?
Which techniques facilitate adherence in children and adolescents?
When is it appropriate or necessary to disclose HIV serostatus?
How do you prepare a child for disclosure?
What do you do when a family refuses to disclose to the child?
How do you prepare a child and family to transfer from a pediatric setting to an adult setting?
Conclusion
References
Web sites
12 Uninfected children of parents with HIV
Introduction
How should a clinician approach a young child who is HIV affected?
How should Angela be assessed?
What cultural issues should the clinician consider when treating children of HIV-positive parents?
What role will a child’s capacity to form attachments play in her ability to utilize treatment?
Is disclosure necessary for therapy to be successful?
How might Angela’s life have been different if she had an HIV-seropositive sibling? Is there …
What role will Wendy’s capacity to attach play in her ability to utilize treatment?
What developmental issues are significant for an adolescent affected by HIV?
What are the countertransference issues the therapist may have been dealing with?
How has the course of treatment changed in parts of the world where HIV medications are available?
Conclusion
References
Suggested reading
13 Psychological issues faced by gay men
Introduction
Review of psychoanalytic theory
The issue of gender identity
How do shame and stigma concerning early childhood gender-nonconformity affect psychological develop
How does growing up gay lead to inhibition and the splitting off of sexuality from relationships?
What is the specific importance of adolescence in gay male development?
How do homophobia and low self-esteem influence the practice of safer sex?
What specific developmental issues exist for gay men as they move from adolescence to adulthood?
What issues should a gay man with HIV consider when deciding to raise a child?
Conclusion
References
14 Women and HIV
Introduction
What are the risk factors for HIV transmission in women?
What is the impact of HIV on women, sex, and relationships?
Do women respond differently than men to HIV treatments?
What health issues do women with HIV infection face?
How does stigma affect women?
What factors can influence adherence in women?
What parenting issues do HIV-positive women face?
What are the reproductive/sexual health concerns of HIV-positive women?
What is involved in the diagnosis and care of pregnant women with HIV?
What are the effects of HIV diagnosis during pregnancy?
What is the role of pre- and post-test counseling?
Pretest counseling
Post-test counseling
HIV negative
HIV positive
Is decision making more difficult at a time of heightened anxiety?
What are women’s concerns about wider family infection?
What is the nature and extent of emotional trauma at the time of HIV diagnosis?
How can care be prioritized?
How can women maximize their coping skills?
What is involved in planning care for women with HIV?
What are the guiding principles for planning care?
What are the issues surrounding the concept of women and power?
Conclusion
References
15 Couples
Introduction
What impact can HIV have on a relationship?
What impact can HIV infection have on sexuality in a couple?
What is the role of couple therapy in addressing communication difficulties?
How can clinicians maintain confidentiality in couple therapy?
When is individual therapy more appropriate?
What effect can adherence to antiretroviral medications have on a couple?
Is group therapy useful for couples?
What impact does caregiving have on the couple?
What impact does caregiving have on the caregiver?
What is the emotional impact on caregivers?
Does the severity of illness affect the caregiving burden?
How important is social support?
Are partners of individuals with HIV at increased risk of suicide?
What are the best coping strategies for caregivers?
Are there specific issues for gay couples?
Are there specific difficulties for couples who are both positive?
Conclusion
References
16A HIV and cultural diversity
Introduction
How does cultural diversity affect assessment?
How does cultural diversity affect treatment planning?
References
16B African Americans
Introduction
What are some of the historical factors that account for the difficulty many African Americans have
How do racial differences affect the ability to develop a therapeutic relationship?
How can the psychiatrist help address issues of adherence when working with African American patient
What additional issues need to be considered when working with African American women with HIV?
What is the significance of child bearing and child raising in the African American community?
What are the issues facing African American men who have sex with men?
Conclusion
References
Suggested Further Reading
Websites
16C Latinos and HIV disease
Introduction
How important is the family for HIV-positive Latinos?
How is homosexuality perceived in Latino cultures?
How would the situation be different for Benito if he were heterosexual?
What can the clinician do to increase adherence?
How do the personal responsibilities of Latinas with HIV affect their medical care?
What coping resources can Latinas with HIV draw on to help them live with their diagnosis and concom
How can a Latina with HIV be empowered to negotiate safer sexual practices with her sexual partner?
Conclusion
References
Web Sites
16D One heart, two spirit, and beyond: HIV and the people of the First Nations
Introduction
What impact has HIV infection had on Native communities?
What is the Native concept of sexuality and gender?
What is the basis for Native mistrust of non-Natives?
What kind of traditional ceremony can be helpful to Native patients?
What is the place of parenting in the Native culture?
Are there traditional ceremonies that could be useful to Marie and her daughter?
When are Natives better served by a culturally specific service?
What are some strategies for working with Native patients?
Conclusion
References
Suggested Further Reading
17 HIV in prison populations
Introduction
What should be included in the initial medical assessment of an inmate?
How should correctional institutions approach HIV testing?
How is treating psychiatric illness different in the presence of HIV?
How can healthcare providers influence an inmate’s behavior?
How can correctional institutions keep an inmate’s HIV status confidential?
Are there any circumstances where an inmate’s HIV status should be disclosed to prison staff?
How can providers ensure continuity of care when inmates are released into the community?
What impact does the prison environment/culture have on healthcare?
Conclusion
References
18 Legal and ethical issues
Introduction
Can George be denied admission based on his HIV-serostatus and the potential risk he represents to o
Can George’s HIV status be disclosed to other patients?
How can the hospital protect other patients and staff from the risk of being infected by George?
In the midst of an epidemic of such proportion, why is there such a strong emphasis on confidentiali
What steps can be taken when patients are discharged to reduce the risk of transmission associated w
Can Laura’s partners be notified of her diagnosis?
What is the clinical approach to a patient with HIV who puts others at risk?
What are some countertransference issues in working with patients who put others at risk?
What can be done about patients who will not change their behaviour and seem to disregard the safety
What are the legal issues that Marc should be addressing?
Are there any particular considerations for people with advanced HIV disease who want to write a wil
How does a clinician determine a patient’s competence to make medical decisions?
What are some of the psychosocial factors that may affect competence to refuse life-saving measures?
What are some of the factors specifically related to HIV infection that can complicate a competency
Conclusion
References
Suggested further Reading
19 Psychiatrist as caregiver
Introduction
What are the sources of the psychiatrist’s discontent?
How can the psychiatrist approach his own countertransference issues with a patient?
What are the potential long-term consequences of the psychiatrist’s discontent?
What personal interventions are important for professional self-care?
What organizational interventions are important for professional self-care?
How does the death of the patient affect the psychiatrist?
How can the psychiatrist cope with the poor outcome?
Conclusion
References
Organizations specializing in physician stress
Websites with information on physician burnout
Appendix I: HIV counseling guidelines for physicians
Pretest counseling
Post-test counseling
Other important issues (emphasize early if poor follow-up is likely)

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Tags: Kenneth Citron, Marie JosA Brouillette, Alexandra Beckett, Psychiatry, HIV, Resource Manual