Mental Health Comorbidity and HIV/AIDS
New data on the incidence and prevalence of HIV both in the United States and throughout the world underscore the continuing magnitude of the AIDS epidemic clearly. There are now an estimated 1.2 million people in the United States and 34 million people i
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Introduction New data on the incidence and prevalence of HIV both in the United States and throughout the world underscore the continuing magnitude of the AIDS epidemic clearly. There are now an estimated 1.2 million people in the United States and 34 million people in the world living with HIV, with 2.7 million new infections in the world in 2010, including an estimated 390,000 among children (UNAIDS, 2011). The UNAIDS report urgently calls for accelerated responses from countries in efforts to completely halt the spread of the disease and highlights the declining incidence and death rate from the disease. However, there are still no current cures or available vaccines. Although medications which are available to manage HIV have been helpful in decreasing the ravages of the disease and prolonging life, each has drawbacks. We in health care must be prepared to manage HIV and AIDS for decades to come. Psychiatric comorbidity in persons living with HIV is relatively high, specifically for psychiatric diagnoses such as depression and substance use disorders, as well as certain anxiety disorders, psychotic disorders, and cognitive disorders. The reverse relationship also seems to be true, namely that in general psychiatric populations, the rates of HIV infection are elevated. Furthermore, persons living with HIV are specifically at risk for increased symptoms related to psychiatric disorders. In some of these conditions the relationship is bidirectional; for example, persons with substance use disorders have a higher likelihood of also having HIV. In this chapter, we discuss the relationships between mental health and HIV, including the role of mental health in HIV transmission and treatment, the role of HIV in psychiatric illness and its course, and current recommendations for assessment and treatment of mental health in persons living with HIV.
K.K. Busby • S. Lytle • M. Sajatovic (*) Department of Psychiatry, University Hospitals Case Medical Center, Cleveland, OH, USA e-mail: [email protected] S. Loue (ed.), Mental Health Practitioner’s Guide to HIV/AIDS, DOI 10.1007/978-1-4614-5283-6_2, # Springer Science+Business Media New York 2013
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Sample Clinical Treatment Scenario The following composite case from a clinical practice setting demonstrates some of the relevant issues for consideration in assessment and treatment of people with mental health and HIV comorbidity. A 45-year-old man presented to a community mental health center for treatment of depression and difficulty with attention. He reported that his mood symptoms had been severe since his mid-20s, including persistent low mood and thoughts of death. Although he indicated that he had also had low moods and poor attention in childhood, these had not been severely disabling and he had obtained some higher education and was a talented musician. He had used street drugs heavily at times, most notably having developed a methamphetamine addiction which peaked in his 20s and 30s. However, he states he has not used methamphe
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