Frank Fernandez, MD
Professor and Chair
Director, Institute for Research in
Psychiatry and Neurosciences
University of South Florida
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Q: What are the most prominent psychiatric complications in people with HIV/AIDS? What symptoms are usually the first to appear?A: The three most common psychiatric complications are depressive disorders, cognitive disorders and substance abuse disorders. The difficulty between the depression and the cognitive disorders is that the symptoms overlap in the sense that people can have mood disturbance, a change in personality, some degree of sadness, and certainly sleep disturbance that can occur as part of both the type of cognitive disturbance that can occur, but also secondary to depression, so the differential diagnostic considerations there are the greatest. They are the most difficult to treat when they are so-called “triply diagnosed” meaning that they have both a dual diagnosis, an axis one and axis two disorder, or two axis one disorders in addition to co-morbid medical problems along with HIV. Obviously, if they have a substance use disorder, that makes treatment much more difficult.
A: They are very common; in fact, if you look at the instance and prevalence of these three disorders in HIV infected populations, they are greater than even that in the non-infected populations that might be at high risk as well. So it seems that the individuals that are more prone to perhaps expose themselves to HIV for varying reasons have a higher incidence and prevalence of depression and cognitive disturbance as in substance use disorders.
Q: How common are psychiatric complications in people with HIV/AIDS?
Q: Are there age groups that are more commonly affected by the psychiatric complications of HIV/AIDS?A: There is an overlap between the ages of the people that get exposed to HIV and the first onset of psychiatric disorders. For example, even with psychotic disorders like schizophrenia, it’s any group really that has any difficulty with impulse control or poor judgment, so in reality that cuts across many diagnoses in the DSM IV.
A: Absolutely, and people with psychiatric complications of HIV/AIDS should warrant the same aggressive approach for their psychiatric diagnosis as they do for their HIV disease. The problem may be related to treatment adherence and treatments that do not interfere pharmacologically with the effectiveness of the antiretroviral regiments for HIV.
Q: Are there effective treatments for psychiatric complications of HIV/AIDS?
Q: Is psychiatric treatment more difficult in people with HIV/AIDS? What are the major obstacles?
A: I think one of the issues is coordinating the care. Collaborative care between the different specialties whether they be behavioral health, immunologists, infectious disease, primary care, neurology and addiction specialists is the most difficult thing. Ideally one would like to have one stop shopping so that everybody could get their care in one place and not have it be fragmented. It’s very difficult to get coordinated and collaborative care for the patients.
Mood disorders are the most frequent complication associated with HIV, more so than cognitive disturbances. They are more prevalent in people that are at high risk for HIV and obviously secondary to either of the medications or treatments that are being used for other medical complications associated with HIV. But there are strategies that can be used to familiarize the symptoms. It is important to note that the suicide risk for these patients is elevated across the entire trajectory of the disease. So even if somebody is well controlled, because of the uncontrollable factors in their life they may be at increased risk for suicide.