NEW ORLEANS – For neurologic and psychiatric issues in HIV patients, several factors should be considered, Dr. Marshall Forstein said at the American Psychiatric Association's Institute on Psychiatric Services.
Psychopharmacology should be used carefully, and patients should be monitored for CNS effects.
In addition, drug-drug interactions should be considered. It is important to keep in mind, for example, that HIV medications may alter absorption of other medications and that induction/inhibition of CP450 may alter drug levels, Dr. Forstein noted.
Common treatments for depression in HIV include selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, novel antidepressants, tricyclic antidepressants, psychostimulants, and hormonal treatments.
The start-low/go-slow approach often taken with elderly patients should be applied here as well.
Comorbid substance abuse should be monitored; several dangerous interactions can occur between HIV treatments and recreational drugs, said Dr. Forstein, who is with the department of psychiatry at the Harvard School of Medicine, Boston.
As for psychotherapy, several common themes among HIV patients have emerged and should be addressed, including:
▸ Loss.
▸ Anger.
▸ Control (decision making).
▸ Death and dying.
▸ Impact of HIV on partners and children.
▸ Fear.
▸ Disclosure.
▸ Sexuality.
▸ Spirituality.
▸ Guilt and regret.
▸ Self-criticism and self-esteem issues.
▸ Stigma and discrimination.
▸ Suicide, including physician-assisted suicide.
Importantly, several effective strategies are available for the management of mood disorders and psychiatric complications in HIV patients, Dr. Forstein said.
One study showed that about half of depressed HIV patients were not treated with antidepressants, and those not treated had 50% lower survival than those who were treated.
All HIV patients who have mood disorders or other psychiatric symptoms should be offered aggressive and timely treatment, he concluded.