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Walkup J, Crystal S, Sambamoorthi U. Schizophrenia and major affective disorder among medicaid recipients with HIV AIDS in New Jersey. Am J Public Health. 1999;89(7):1101–3.PubMedCrossRef
Blank MB, Mandell DS, Aiken L, Hadley TR. Co-occurrence of HIV and serious mental illness among Medicaid recipients. Psychiatr Serv. 2002;53(7):868–73.PubMedCrossRef
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• Blank MB, Himelhoch SS, Balaji AB, Metzger DS, Dixon LB, Rose CE. A Multisite Study of the Prevalence of HIV using Rapid Testing in Mental Health Settings. American Journal of Public Health. in press. The objective was to estimate HIV prevalence and risk factors among persons receiving treatment in mental health settings in Philadelphia and Baltimore. 1062 individuals were tested for HIV who were receiving services in three settings: University-based inpatient psychiatric units (N=288), assertive community treatment programs (ACT, N=273), and community mental health centers (CMHCs, N=501). The proportions with confirmed positive HIV test results were 5.9% for inpatient units, 5.1% for ICM programs, and 4.0% for CMHCs. HIV infection was associated with black race, homosexual or bisexual identity, HCV infection, and overall psychiatric symptom severity. The authors recommend routine opt-out testing for all inpatient and outpatient mental health treatment settings.
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Himelhoch S, Chander G, Fleishman JA, Hellinger J, Gaist P, Gebo KA. Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use. General hospital psychiatry. 2007;29(6):518–25.PubMedCrossRef
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• Blank MB, Eisenberg MM. Tailored treatment for HIV+ persons with mental illness: the intervention cascade. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2013;63:S44–8. The public health literature demonstrates disturbingly high HIV risk for persons with a serious mental illness (SMI), who are concurrently co-morbid for substance abuse (SA). Many HIV positives have not been tested, and therefore do not know their status, but for individuals who are triply diagnosed, adherence to HIV treatment results in meaningful reductions in viral loads and CD4 counts. Barriers to treatment compliance are reviewed, low threshold/low intensity community based interventions are discussed, and preliminary evidence is presented for the efficacy of the Intervention Cascade, defined as an integrated intervention delivered by specially trained nurses who individualize a treatment compliance intervention in real time as an adaptive response to demand characteristics of the individual
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Rothbard AB, Blank MB, Staab JP, et al. Previously Undetected Metabolic Syndromes and Infectious Diseases Among Psychiatric Inpatients. Psychiatric services. 2009;60(4):534–7.PubMedCrossRef
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Lopes M, Olfson M, Rabkin J, et al. Gender, HIV status, and psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry. 2012;73(3):384–391. The prevalence of 12-month psychiatric disorders among HIV-positive and HIV-negative adults was stratified by sex to examine the differential increase in risk of a psychiatric disorder as a function of the interaction of sex and HIV status using the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. HIV-positive men were more likely than HIV-negative men to have any mood disorder, major depressive disorder/dysthymia, any anxiety disorder, and any personality disorder. The same comparisons were not significant in comparisons of HIV positive and HIV negative women.
association Ap. Practice guideline for the treatment of patients with HIV/AIDS: American Psychiatric Pub; 2000.
• Freudenreich O, Goforth HW, Cozza KL, et al. Psychiatric treatment of persons with HIV/AIDS: an HIV-psychiatry consensus survey of current practices. Psychosomatics. 2010;51(6):480–8. 159 members of the Organization of AIDS Psychiatry (OAP) participated in a web-based survey to determine consensus on current treatment trends in AIDS psychiatry. With a response rate of only 39% (n=69), findings should be carefully considered but promising trends in agreement were observed for first-line treatment for depression (escitalopram/citalopram), for psychosis and secondary mania (quetiapine), and for anxiety (clonazepam)
Himelhoch S, Powe NR, Breakey W, Gebo KA. Schizophrenia, AIDS and the decision to prescribe HAART: results of a national survey of HIV clinicians. J Prev Interv Community. 2007;33(1/2):109–20.PubMedCrossRef
Cohen MA, Forstein MA, Cohen MA, Forstein M. Biopsychosocial Approach to HIV/AIDS Education for Psychiatry Residents. Academic Psychiatry. 2012;36(6):479–86. This article discusses the importance of HIV/AIDS training for psychiatry residents and proposes an HIV/AIDS curriculum using a biopsychosocial approach that can be integrated into the standard 4 year residency training programs.PubMedCrossRef
Simoni JM, Safren SA, Manhart LE, et al. Challenges in addressing depression in HIV research: assessment, cultural context, and methods. AIDS and behavior. 2011;15(2):376–88. Depression, as a common co-morbidity of HIV infection is associated with reduced quality of life and poor health outcomes. This paper reviews diagnostic, screening, and symptom-rating measures of depression and includes a discussion of cross-cultural measurement issues.PubMedCrossRef
• Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2011;58(2):181–7. A meta-analysis of 95 independent samples was conducted of the relationship between depression and HIV medication nonadherence in order to evaluate the overall effect size and examine potential methodological and measurement moderators. Depression was significantly associated with nonadherence, with larger effects for studies that collected data via interviews versus self-administered questionnaires and when considered along a continuum rather than as a dichotomous variable. No relationship was observed for assessment interval (ie, cross-sectional vs. longitudinal), sex, IV drug use, sexual orientation, clinical severity, or study location. Depression, even at subclinical levels, should be included within HIV behavioral interventions.
Kessler RC, Birnbaum H, Bromet E, Hwang I, Sampson N, Shahly V. Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R). Psychological medicine. 2010;12(2):225.CrossRef
Kalichman SC. HIV Treatments as Prevention (TasP): Primer for Behavior-based Implementation: Springer; 2013.
Rabkin JG, McElhiney MC, Ferrando SJ. Mood and substance use disorders in older adults with HIV/AIDS: methodological issues and preliminary evidence. Aids. 2004;18:43–8.CrossRef
Smith RD, Delpech VC, Brown AE, Rice BD. HIV transmission and high rates of late diagnoses among adults aged 50 years and over. Aids. 2010;24(13):2109–15.PubMedCrossRef
• Carrico AW, Bangsberg DR, Weiser SD, Chartier M, Dilworth SE, Riley ED. Psychiatric correlates of HAART utilization and viral load among HIV-positive impoverished persons. AIDS (London, England). 2011;25(8):1113. A cross-sectional community-recruited study of 227 HIV-positive homeless or marginally homeless participants examined psychiatric correlates of highly active antiretroviral therapy utilization and viral load. Investigators reported a diagnosis of severe mental illness (SMI) was independently associated with higher viral load than those without an SMI diagnosis. Authors emphasize the importance of ‘test and treat’ among homeless SMI/HIV positives
• Carrico AW, Riley ED, Johnson MO, et al. Psychiatric risk factors for HIV disease progression: The role of inconsistent patterns of anti-retroviral therapy utilization. Journal of acquired immune deficiency syndromes (1999). 2011;56(2):146. Outcome data from 603 participants randomized to a behavioral intervention examined whether inconsistent patterns of ART utilization partially mediated the effects of depression and substance use on higher HIV viral load over a 25-month follow-up. Elevated affective symptoms of depression independently predicted ART discontinuation, and use of stimulants at least weekly independently predicted intermittent ART utilization. After controlling for the average self-reported percentage of ART doses taken and baseline T-helper (CD4+) count, elevated depressive symptoms predicted a 50% higher mean viral load, and weekly stimulant use predicted a 137% higher mean viral load. These effects became non-significant after accounting for inconsistent patterns of ART utilization, providing evidence of partial mediation. Inconsistent patterns of ART utilization may partially explain the effects of depression and stimulant use on hastened HIV disease progression
• Himelhoch S, Medoff D, Maxfield J, et al. Telephone Based Cognitive Behavioral Therapy Targeting Major Depression Among Urban Dwelling, Low Income People Living with HIV/AIDS: Results of a Randomized Controlled Trial. AIDS and behavior. 2013:1–9. A manualized telephone based cognitive behavioral therapy (T-CBT) intervention was compared to face-to-face therapy among 34 low-income, urban dwelling HIV infected depressed participants of a pilot randomized controlled trial, with reduced depression a primary outcome., and medication adherence as secondary outcome. No between group differences were observed with participants in both groups displaying reductions in depressive symptoms. Participants in the T-CBT group displayed better treatment adherence. Study suggests the potential for T-CBT as an alternative to f2f treatment.
de Sousa Gurgel W, da Silva Carneiro AH, Barreto Rebouças D, et al. Prevalence of bipolar disorder in a HIV-infected outpatient population. AIDS care. 2013(ahead-of-print):1–5. Prevalence of bipolar disorder (BD) was assessed among 196 HIV-infected adult Brazilian outpatients. Mood Disorder was found in 13.2% (N=26) and the Bipolar Disorder was confirmed in 8.1% (N=16) of the sample, a BD prevalence almost four times higher among the HIV-infected than in the general USA population. The most common psychiatric comorbidity in the BD group was substance abuse (61.5%).
Meade CS, Bevilacqua LA, Key MD. Bipolar Disorder is Associated with HIV Transmission Risk Behavior Among Patients in Treatment for HIV. AIDS and behavior. 2012;16(8):2267–71. HIV transmission risk behavior was examined among 63 patients with bipolar disorder (BD), major depressive disorder, and no mood disorder; half had substance use disorders (SUDs). BD patients displayed highest risk behaviors relative to the other groups and poorest treatment adherence.PubMedCrossRef
Chander G, Himelhoch S, Moore RD. Substance abuse and psychiatric disorders in HIV-positive patients. Drugs. 2006;66(6):769–89.PubMedCrossRef
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Vitiello B, Burnam MA, Bing EG, Beckman R, Shapiro MF. Use of psychotropic medications among HIV-infected patients in the United States. Am J Psychiatr. 2003;160(3):547–54.PubMedCrossRef
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• Martin L, Kagee A. Lifetime and HIV-Related PTSD Among Persons Recently Diagnosed with HIV. Aids and Behavior. 2011;15(1):125–31. Eight-five recently diagnosed HIV-positive patients in the Western Cape, South Africa participated in a cross-sectional study of lifetime rates of PTSD and HIV-related PTSD , resulting in a lifetime rate for PTSD of 54.1% and HIV-related PTSD of 40%. This demonstrates the degree of stress associated with an HIV diagnosis, and highlights the importance of considering the individual’s psychological preparation for positive test results
Himelhoch S, Medoff DR. Efficacy of antidepressant medication among HIV-positive individuals with depression: A systematic review and meta-analysis. Aids Patient Care and Stds. 2005;19(12):813–22.PubMedCrossRef
Foa EB, Hembree EA, Cahill SP, et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. J Consult Clin Psychol. 2005;73(5):953–64.PubMedCrossRef
Benton T, Blume J, Dube B. Treatment considerations for psychiatric syndromes associated with HIV Infection. Future Medicine. 2010;4(2):231–45.
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Allison DB, Newcomer JW, Dunn AL, et al. Obesity among those with mental disorders: a National Institute of Mental Health meeting report. American journal of preventive medicine. 2009;36(4):341–50.PubMedCrossRef
Walkup J, Blank MB, Gonzalez JS, et al. The impact of mental health and substance abuse factors on HIV prevention and treatment. Jaids-Journal of Acquired Immune Deficiency Syndromes. 2008;47:S15–9.CrossRef
• Wu ES, Rothbard A, Blank MB. Using Psychiatric Symptomatology to Assess Risk for HIV Infection in Individuals with Severe Mental Illness. Community Ment Health J. 2011;47(6):672–8. The Colorado Symptom Index (CSI) was used to identify vulnerable subgroups within the severely mentally ill population at elevated risk for HIV infection. Baseline data on 228 HIV positive and 281 HIV negative participants from two clinical trials, years to HIV diagnosis served as the primary endpoint. A CSI score>=30 was associated with a 47% increased risk for HIV infection (P<0.01). This study establishes the foundation for using CSI scores to identify a vulnerable subgroup within the SMI community. Further studies should develop effective approaches to mitigate psychiatric symptomatology in order to examine the impact on HIV transmission risky behaviors
Dévieux JG, Malow R, Lerner BG, et al. Triple jeopardy for HIV: substance using severely mentally ill adults. Journal of prevention & intervention in the community. 2007;33(1–2):5–18.CrossRef
• Prince JD, Walkup J, Akincigil A, Amin S, Crystal S. Serious mental illness and risk of new HIV/AIDS diagnoses: an analysis of Medicaid beneficiaries in eight states. Psychiatric services. 2012;63(10):1032–8. Medicaid claims data in 5 states was linked to compare the influence of substance abuse, HIV and mood disorder to identify risk factors for psychiatric hospitalization and early readmission within 3 months of discharge. Logistic and Cox regression revealed 24% of beneficiaries (N=129,524) with mood disorder were hospitalized, and 24% of that group were re-hospitalized within the 3 month review period. The addition of substance abuse accounted for 36% of initial hospitalizations and 50% of readmissions. Comorbid disorders should be treated within a multi-discipline partnership between mental health, infectious disease, and substance abuse professionals
• Cournos F, Guimarães MD, Wainberg ML. HIV/AIDS and Serious Mental Illness: A Risky Conclusion. Psychiatric services. 2012;63(12):1261–1261. Authors provide a counter-argument to the Prince, Walkup , Akincigil et al. 2013 Psychiatric Services paper which concluded that “for their sample “a severe mental illness diagnosis in the absence of a substance abuse diagnosis was not highly associated with increased risk of a new HIV/AIDS diagnosis””. Authors point to the lack of full data and inadequate analyses, as well as to the difficulty of focusing on one diagnostic category to the exclusion of others, when substance abuse and mental illnesses are often inextricably related.
Lee AK, Hanrahan NP, Aiken LH, Blank MB. Perceived facilitators and barriers to the implementation of an advanced practice: nursing intervention for HIV regimen adherence among the seriously mentally ill. Journal of psychiatric and mental health nursing. 2006;13(5):626–8.PubMedCrossRef
• Hanrahan NP, Wu E, Kelly D, Aiken LH, Blank MB. Randomized Clinical Trial of the Effectiveness of a Home-Based Advanced Practice Psychiatric Nurse Intervention: Outcomes for Individuals with Serious Mental Illness and HIV. Nursing research and practice. 2011. doi:10.1155/2011/840248
. Two-hundred and thirty-eight community-dwelling individuals with HIV and serious mental illness (SMI) were randomly assigned either to an intervention group that received care management from an advanced practice psychiatric nurse or to a control group that received treatment as usual. Those in the intervention group demonstrated reductions in depression and improvements in the physical component of health-related quality of life, highlighting the promise of using advanced practice psychiatric nurses to improve quality of care and outcomes for complex patients
Collins L, Murphy S, Bierman K. A Conceptual Framework for Adaptive Preventive Interventions. Prev Sci. 2004;5(3):185–96.PubMedCrossRef
• Blank M, Hennessy M, Eisenberg M. Increasing Quality of Life and Reducing HIV Burden: The PATH+ Intervention. AIDS & Behavior. 2013 Sep 3. [Epub ahead of print]. The heightened risk of persons with a serious mental illness (SMI) to contract and transmit human immunodeficiency virus is a public health problem. In order to test the effectiveness of a community-based advanced practice nurses intervention to promote adherence to HIV and psychiatric treatment regimens, 238 HIV-positive participants who also were in treatment for a serious mental illness were randomized to an nurse led intervention, Preventing AIDS Through Health for Positives (PATH+), or treatment-as-usual. The study examined viral load and CD4 count at baseline, 12 and 24 months, and health-related quality of life measures (SF-12 Mental and Physical Health) at baseline, 3, 6, 12, and 24 months. Participants were followed for 12 months after PATH ended in order to examine any radiating effects of decay of the intervention. Latent growth curve model using three data points for biomarkers (baseline, 12 & 24 months) and five data points for health related quality of life (baseline, 3, 6, 12, & 24 months) shows moderate to excellent fit for modeling changes in CD4, viral load, and mental SF-12 subscales. This project demonstrates the effectiveness of PATH+ and its community-based, individually-tailored intervention cascade, to improve outcomes of individuals with HIV/SMI. With appropriate support, persons with SMI and HIV can successfully adhere to treatment and achieve improvements in health-related quality of life and biomarker health status indicators.