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| POSITION STATEMENT ON HIV IN PSYCHIATRY BY THE SOUTH
AFRICAN SOCIETY OF PSYCHIATRISTS |
H IV infection and mental health/disorders are intimately
connected in a number of ways.
- The neuro-psychiatric manifestations of infection
with HIV . These range from minor cognitive motor
disorder to HIV dementia and new onset psychosis and mania.
Where patients with HIV infection present with psychiatric
manifestations, it is critical that practitioners accurately
stage the infection and determine the need for anti-retroviral
treatment. HIV Dementia and new onset psychosis and mania
usually indicate late stage-3 or stage-4 disease and indicate
the need for antiretroviral treatment even if the CD4 count is
above 200/ml.
- Such patients should not be denied treatment on the basis
of their mental state, nor should any patient by denied
optimal psychiatric care because of his/her HIV status .
- Interventions to ensure adherence must be put into place in
situations where it is difficult for the patient him/herself to
adhere.
- The issue of diagnosis of HIV-status is
complicated in people with severe psychiatric disorders because
of the issues around informed consent for voluntary counselling
and testing. In addition, dealing with a diagnosis of HIV in an
individual who may already be compromised in terms of their
psychological functioning, can be very difficult. This requires
sensitivity on the part of practitioners and knowledge of
guidelines for testing for HIV-status in such individuals.
- Generally, testing should be done with full
informed consent and adequate pre- and post-test
counselling. Guidelines exist for situations where
informed consent is not possible and testing is necessary.
- With the availability of Anti-Retroviral Treatment, it is
particularly important to ensure that the diagnosis of HIV
infection is made where there is clinical suspicion as it is
ethically unacceptable to deprive someone of the opportunity
to access appropriate treatment for this life-threatening
infection.
- It is also important to actively look for and treat
opportunistic infections , particularly in in-patient
settings where overcrowding may be an issue, and infections such
as Tuberculosis can so easily spread.
- The psychosocial implications of a
diagnosis of HIV for an infected individual and their loved ones
clearly fall within the ambit of mental health. This is seen in
the increasing number of infected and affected individuals who
are seen in mental health services with depression, suicidal
behaviour, and other mental disorders. It is a concern that
there are many other people (particularly children and
adolescents) who suffer mentally as a result of HIV without ever
receiving any treatment.
- The impact of the epidemic on children and
adolescents: An increased incidence of anxiety and mood
disorders as well as disruptive behavioural disorders may be
expected in children, and reduced access to education and other
resources may exacerbate their distress and impairment. C
aregivers may need help to guide children through the many
challenges they face, such as fear of the loss of parents and
home, rejection by peers, exploitation, own medical stressors or
early death, due to lack of understanding of normal child and
family development and emotional needs, or caregivers' own
psychological ‘blindness', or lack of parenting skills as well
as to identify or resolve early signs of maladaptive emotional
development or behaviour in child or family.
- The psychosocial vulnerability of children
who are orphaned or otherwise negatively affected by
HIV/AIDS must be taken into account when planning and
delivering child and adolescent mental health services.
- Information regarding available treatment services for
children as well as information regarding abnormal development
and functioning must be made widely known, especially to
caregivers of children infected and affected by HIV/AIDS.
- Services should as far as possible be available in a
non-stigmatising way (both in terms of HIV and mental
illness).
- People with severe psychiatric disorders
may be at increased risk of contracting HIV as a result of
high-risk behaviours, and other mental health issues such as
gender violence and substance abuse put people, particularly
women and children, at risk of contracting HIV. This makes it
imperative that psychiatrists play an active role in prevention
efforts in these vulnerable groups.
It is our responsibility as psychiatrists working in South
Africa to address the epidemic at all levels, in particular with
regard to the psychiatric consequences of the HIV epidemic and to
ensure that the patients that we care for (including children and
adolescents) receive the appropriate treatment (for both their
medical and psychiatric conditions).
The psychosocial implications of HIV infection make it
imperative that medical and mental health/psychiatric services
work together actively to provide holistic care for people
infected with or affected by HIV. Psychiatrists are encouraged to
develop working partnerships with HIV physicians and primary care
practitioners in their area of practice in order to provide a
better service to our people.
Prepared by Rita Thom
Convenor of HIV Special Interest Group
On behalf of the South African Society of Psychiatrists
April 2006 |
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