RESUMO
Approximately 1 million persons are now infected with human immunodeficiency virus (HIV) in the United States. Evidence exists that psychiatric disorders are common in patients with HIV and that these patients may not receive optimal care because their psychiatric disorders are a barrier to medical care, communication with clinicians, and adherence to medical recommendations. We describe herein a complex case seen at The Johns Hopkins Hospital with several psychiatric conditions that are common in our HIV clinic population. We describe the collaborative treatment of the patient by a multidisciplinary team including both medical and mental health practitioners. We briefly describe a coherent diagnostic and treatment approach to patients in HIV clinics and the supporting rationale from the literature. We discuss the need for comprehensive evaluation, a multidisciplinary treatment team, and therapeutic optimism.
Assuntos
Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/tratamento farmacológico , Endocardite Bacteriana/complicações , Infecções por HIV/complicações , Infecções por HIV/terapia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Antidepressivos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Desipramina/uso terapêutico , Endocardite Bacteriana/terapia , Feminino , Infecções por HIV/psicologia , Humanos , Competência Mental , Transtornos do Humor/complicações , Transtornos da Personalidade/complicações , PsicoterapiaRESUMO
Major depression and demoralization are very common in patients with cancer. A discussion of the diagnostic specificity of major depression and demoralization (also known as adjustment disorder) is presented here, followed by a review of some effects of comorbid depression and cancer. Finally, there are a brief review of studies of antidepressant pharmacotherapy in cancer patients, a treatment algorithm for antidepressant therapy, and suggestions for treatment of demoralization.
Assuntos
Transtornos de Adaptação , Antidepressivos/farmacologia , Transtorno Depressivo Maior , Neoplasias/psicologia , Transtornos de Adaptação/diagnóstico , Transtornos de Adaptação/etiologia , Transtornos de Adaptação/terapia , Algoritmos , Antidepressivos/uso terapêutico , Aconselhamento , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/etiologia , Transtorno Depressivo Maior/terapia , Humanos , Educação de Pacientes como Assunto , Prevalência , PsicoterapiaRESUMO
Psychiatric disorders increase the risk of acquiring human immunodeficiency virus (HIV) and increase morbidity from HIV-related illness by impeding treatment. The response to highly active antiretroviral therapies is impaired by poor patient adherence, a substantial component of which is related to mental illness and substance use disorders. The recognition of psychiatric disorders in most HIV clinics is an issue of utmost importance. We outline diagnostic and treatment issues for major depression, bipolar disorder, personality disorder, substance use disorders, and demoralization as seen in patients with HIV. Our experience at the Johns Hopkins Moore (HIV) Clinic has led us to conclude that treatment of these disorders greatly improves patient adherence to treatment and outcomes of HIV infection.