HIV-infected mental health patients: characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients

OBJECTIVES: HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60%) are homosexual men. The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms. METHODS: We compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study) and with non-HIV infected mental health patients (NESDA-study). DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms. RESULTS: Depressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group. CONCLUSION: Habitual drug use is a risk factor for spreading HIV. It is also more often diagnosed in HIV-infected homosexual men with a lifetime depression or dysthymic disorder than in the non-infected population. Untreated mental health problems, such as depressive symptoms and use of drugs can have serious repercussions. Therefore, general practitioners and internists should be trained to recognize mental health problems in HIV-infected patients

Atypisch delier: gevaar voor onderdiagnostiek en -behandeling: Gevaar voor onderdiagnostiek en -behandeling

An atypical presentation of delirium increases the risk of misdiagnosis and undertreatment. Three cases are presented in this article. A 65-year-old woman, admitted for malnutrition, has significant mood-related symptoms that resemble depression. A 50-year-old male, admitted with an abscess, necrotizing fasciitis and sepsis, appears to be suicidal. A 61-year-old male, admitted with pneumonia, has auditory hallucinations. All three patients turned out to have a delirium. The authors advise ruling out a delirium in all patients who have predisposing factors and who develop an acute psychiatric disorder while staying in the hospital, before considering other psychiatric diagnoses. Advice on how to improve the diagnostic process is given

HIV-infectie en psychische klachten: Een belangrijke en vaak voorkomende combinatie

About 50% of HIV patients have one or more mental disorders such as depression, addiction, anxiety disorders or personality disorders. Two patients, a 58-year-old male and a 38-year-old female, suffered from HIV infection with comorbid mental disorders. The mental disorders interfered with the treatment and outcome of their HIV infection. The first patient attempted suicide and was diagnosed with severe depression. He had stopped taking his antiretroviral combination therapy and had occasionally had unsafe sex. The woman suffered from posttraumatic stress disorder, alcohol abuse and depression. She took her antiretroviral combination therapy irregularly. Both patients received psychiatric treatment. Subsequently, medication adherence improved and the male patient no longer had unsafe sexual contacts. For optimal treatment of HIV infection it is important that comorbid mental disorders are recognized, diagnosed and treated

Hiv-infectie en psychische klachten: een belangrijke en vaak voorkomende combinatie.

About 50% of HIV patients have one or more mental disorders such as depression, addiction, anxiety disorders or personality disorders. Two patients, a 58-year-old male and a 38-year-old female, suffered from HIV infection with comorbid mental disorders. The mental disorders interfered with the treatment and outcome of their HIV infection. The first patient attempted suicide and was diagnosed with severe depression. He had stopped taking his antiretroviral combination therapy and had occasionally had unsafe sex. The woman suffered from posttraumatic stress disorder, alcohol abuse and depression. She took her antiretroviral combination therapy irregularly. Both patients received psychiatric treatment. Subsequently, medication adherence improved and the male patient no longer had unsafe sexual contacts. For optimal treatment of HIV infection it is important that comorbid mental disorders are recognized, diagnosed and treated

HIV infection and psychiatric symptoms:a common and important combination

About 50% of HIV patients have one or more mental disorders such as depression, addiction, anxiety disorders or personality disorders. Two patients, a 58-year-old male and a 38-year-old female, suffered from HIV infection with comorbid mental disorders. The mental disorders interfered with the treatment and outcome of their HIV infection. The first patient attempted suicide and was diagnosed with severe depression. He had stopped taking his antiretroviral combination therapy and had occasionally had unsafe sex. The woman suffered from posttraumatic stress disorder, alcohol abuse and depression. She took her antiretroviral combination therapy irregularly. Both patients received psychiatric treatment. Subsequently, medication adherence improved and the male patient no longer had unsafe sexual contacts. For optimal treatment of HIV infection it is important that comorbid mental disorders are recognized, diagnosed and treated.</p

HIV infection and psychiatric symptoms:a common and important combination

About 50% of HIV patients have one or more mental disorders such as depression, addiction, anxiety disorders or personality disorders. Two patients, a 58-year-old male and a 38-year-old female, suffered from HIV infection with comorbid mental disorders. The mental disorders interfered with the treatment and outcome of their HIV infection. The first patient attempted suicide and was diagnosed with severe depression. He had stopped taking his antiretroviral combination therapy and had occasionally had unsafe sex. The woman suffered from posttraumatic stress disorder, alcohol abuse and depression. She took her antiretroviral combination therapy irregularly. Both patients received psychiatric treatment. Subsequently, medication adherence improved and the male patient no longer had unsafe sexual contacts. For optimal treatment of HIV infection it is important that comorbid mental disorders are recognized, diagnosed and treated.</p

The Relation between Depressive Symptoms and Unsafe Sex among MSM Living with HIV

In people living with HIV (PLWH), a positive association is often found between depressive symptoms and unsafe sex, which means sex without a condom. However, the results of such studies are inconclusive. The present study compared the numbers of safe and unsafe sexual contacts from men who have sex with men (MSM) (N = 159), living with HIV and attending a mental health clinic, with those of HIV-negative MSM in the general population (N = 198). We determined whether the presence of depressive symptoms was associated with unsafe sex in either of the two study populations. The depressive symptoms were measured with the Inventory of Depressive Symptoms (IDS), (MSM living with HIV) and with the 2012 Sexual Health Monitor (HIV-negative MSM). Finally, we determined whether MSM living with HIV with depressive symptoms, who received psychiatric treatment as usual, engaged in fewer unsafe sexual contacts one year after baseline. The mental-health-treatment-seeking MSM living with HIV engaged in more unsafe sexual contact than the MSM comparison group without HIV. Neither the treatment-seeking MSM living with HIV nor the MSM without HIV in the general population exhibited a relationship between depressive symptoms and unsafe sex. Moreover, the successful treatment of depressive symptoms in the treatment group did not lead to any reduction in the number of unsafe sexual contacts. Further research is needed to develop interventions that might be effective for MSM living with HIV with mental health symptoms to reduce the number of unsafe sexual contacts

HIV-infected mental health patients: characteristics and comparison with HIV-infected patients from the general population and non-infected mental health patients

Abstract Objectives HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60%) are homosexual men. The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms. Methods We compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study) and with non-HIV infected mental health patients (NESDA-study). DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms. Results Depressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group. Conclusion Habitual drug use is a risk factor for spreading HIV. It is also more often diagnosed in HIV-infected homosexual men with a lifetime depression or dysthymic disorder than in the non-infected population. Untreated mental health problems, such as depressive symptoms and use of drugs can have serious repercussions. Therefore, general practitioners and internists should be trained to recognize mental health problems in HIV-infected patients.</p

Alcohol-dependent patients with comorbid phobic disorders: A comparison between comorbid patients, pure alcohol-dependent and pure phobic patients

Background: Patients with a double diagnosis of alcohol dependence and phobic disorders are a common phenomenon in both alcohol and anxiety disorder clinics. If we are to provide optimum treatment we need to know more about the clinical characteristics of this group of comorbid patients. Objective: To answer the following questions. (1) What are the clinical characteristics of treatment-seeking alcohol-dependent patients with a comorbid phobic disorder? (2) Are alcohol dependence and other clinical characteristics of comorbid patients different from those of 'pure' alcohol-dependent patients? (3) Are the anxiety symptoms and other clinical characteristics of comorbid patients different from those of 'pure' phobic patients? Method: Three groups of treatment-seeking patients were compared on demographic and clinical characteristics: alcohol dependent patients with a comorbid phobic disorder (n = 110), alcohol-dependent patients (n = 148) and patients with social phobia or agoraphobia (n = 106). In order to diagnose the comorbid disorders validly, the assessment took place at least 6 weeks after detoxification. Results: Comorbid patients have high scores on depressive symptoms and general psychopathology: 25% of patients have a current and 52% a lifetime depressive disorder. The majority have no partner and are unemployed, they have a high incidence of other substance use (benzodiazepine, cocaine, cannabis) and a substantial proportion of comorbid patients have been emotionally, physically and sexually abused. They do not have a more severe, or different type of alcohol dependence or anxiety disorder than 'pure' alcohol-dependent patients and phobic patients respectively. Conclusion: Comorbid patients constitute a complex part of the treatment-seeking population in alcohol clinics and psychiatric hospitals. These findings should be taken into account when diagnosing and treating alcohol-dependent patients with a comorbid phobic disorder

Do comorbid anxiety disorders in alcohol-dependent patients need specific treatment to prevent relapse?

Aims: It has been repeatedly stated that comorbid anxiety disorders predict poor outcome of alcoholism treatment. This statement is based on the high comorbidity of alcohol use disorders and anxiety disorders, and the negative influence of other comorbid psychiatric disorders on the outcome of treatment of alcohol dependence. This review focuses on outcome results of alcohol-dependent patients with a comorbid anxiety disorder. We try to answer the question whether anxiety disorders should be treated in alcohol-dependent patients to improve outcome results in alcoholism treatment. Methods: In a search through Pubmed, Psychinfo and Cochrane, we found only 12 articles on this subject. We distinguished three perspectives: (1) studies on the predictive value of comorbid anxiety disorders on the outcome of alcoholism treatment; (2) studies on the improvement of abstinence rates and anxiety symptoms by offering pharmacological treatment for comorbid anxiety disorders; (3) studies on psychotherapeutic treatment. Results: Most studies showed methodological limitations. Only one high quality study showed that comorbid anxiety disorders predict poor outcome of the treatment of alcohol dependence. Conclusions: We cannot conclude that comorbid anxiety disorders in alcohol-dependent patients need a specific treatment to prevent relapse. However, medication and perhaps cognitive behavioural therapy can be useful in alcohol-dependent patients with a comorbid anxiety disorder to reduce anxiety symptoms. Methodological implications for further research are discusse