1. WPA Section on HIV Psychiatry: How We Got Here Today
Mary Ann Cohen, MD, FAPM, FACP, DLFAPA
Clinical Professor of Psychiatry
Mount Sinai School of Medicine
Chair and Founder, Academy of Psychosomatic Medicine HIV/AIDS Psychiatry Special Interest Group

2. WPA Prague Section Chairs Meeting
October 20, 2012

3. Special Thanks
To WPA President and Founding Member, APM HIV SIG, Pedro Ruiz, MD for introducing our Section to the WPA
To Founding Member and Steering Committee Member,
Cesar A. Alfonso, MD, FAPM for representing me at this meeting
To my Co-Chair and Chair of our HIV SIG Research Task force, Kelly Cozza, MD, FAPM
To all of our members who have attended meetings, collaborated on presentations at the APM, APA, AAPDP, and now the WPA
To all our members who have contributed articles, chapters, and books on HIV psychiatry
To our members, their teams, and their families
To our patients and their families and caregivers

4. History of the Development of the Academy of Psychosomatic Medicine HIV Psychiatry Special Interest Group
Until 2003, there was no organization of psychiatrists and other mental health professionals that was dedicated to the field of AIDS psychiatry
Many mental health clinicians devoted their professional lives to providing care for persons with HIV and AIDS

5. History of the APM HIV SIG
There was a need for a national and international group to provide networking and support for HIV mental health clinicians
There was a need for a forum for the exchange of ideas and collaborative research
There was a need for a group to share knowledge, to present work, and to collaborate in education and research

6. History of the APM HIV SIG
In 2003, with 32 founding members, the APM Executive Council approved my application to establish the HIV SIG initially called the Organization of AIDS Psychiatry
In 2004 our SIG met for the first time at the APM Annual Meeting
Since 2005 we have given presentations at each Annual Meeting as well as at the APA

7. Goals of the APM HIV SIG
Develop a network of mental health professionals working in the area of HIV psychiatry
For brief informal consultations by from members
To exchange ideas about drug-drug interactions, especially HIV medications and psychotropic medications, and the best medications to use for depression, anxiety, and insomnia—as we experience them in practice, until evidence-based research is available
To develop novel ideas for outreach, screening, and treatment
To develop an understanding of best practices in AIDS psychiatry

8. Goals of the APM HIV SIG
Promote awareness of HIV as a public health problem with psychiatric sequelae and associated psychiatric disorders
Develop and promote programs to educate general psychiatrists and other mental health professionals in HIV/AIDS psychiatric complications and treatment
Assist psychiatrists in various clinical settings to develop support for prevention of HIV transmission in their patient populations

9. Goals of the APM HIV SIG
To educate general psychiatrists in inpatient and outpatient psychiatry settings about prevention of HIV transmission in persons with both severe mental illness alone and severe mental illness and addictive disorders
Help develop and implement strategies to reduce stigma associated with being a person with HIV
Develop and promote education and collaborative research on effective clinical and professional practices in HIV Psychiatry
Provide slide sets and education to underserved areas of the US and the world where HIV is prevalent

10. HIV/AIDS: A Paradigm of a Severe and Complex Medical Illness
AIDS is different from other severe and complex medical illnesses
Nonadherence may have serious public health consequences as well as a devastating impact on patients and families
Discrimination and AIDSism may worsen health care disparities and access to care
AIDS is a preventable complex and severe illness
Adherence to risk reduction and care can mean the difference between life and death to self as well as others
Neurocognitive impairment can occur at any age throughout the course of illness and is highly prevalent

11. Development of APM HIV SIG Collaborative Research Projects: Consensus Surveys
Of HIV Psychiatric Treatments
Of Time Required for Initial Psychiatric Evaluation and for Follow Up Visits
Of Neuropsychiatric Symptoms of Efavirenz
Of Screening Tools for HAND
Of Diagnosis and Treatment of HAD
Of Diagnosis and Treatment of HIV-Associated Sleep Disorders
Of Diagnosis and Treatment of HIV-Associated Fatigue

12. Publication of Results of the APM HIV Psychiatry SIG First Consensus Survey
Freudenreich O, Goforth HW, Cozza KL, Mimiaga MJ, Safren SA, Bachmann G, Cohen MA. Psychiatric treatment of persons with HIV/AIDS: an HIV-psychiatry survey of current practices. Psychosomatics 2010; 51:

13. Clinical Pearls for Differential Diagnosis of Psychiatric Symptoms in HIV and AIDS
There is a need for a comprehensive biopsychosocial approach to psychiatric symptom evaluation in persons with HIV/AIDS
This comprehensive approach to differential diagnosis includes exploring clues for infectious, neurologic, and psychiatric causes and requires complete medical, psychiatric, and psychosocial assessments as well as ancillary evaluations
Cohen, 1987, 1992; Cohen et al., 2010; Cohen and Alfonso, 2004; Cohen
and Chao, 2008, Cohen and Gorman, 2008; Cohen and Weisman, 1986,
1988

14. HIV Psychiatry Textbooks by APM HIV Psychiatry SIG Members
Fernandez F, Ruiz P. Psychiatric Aspects of AIDS
Eds. Lippincott Williams & Wilkins, Philadelphia, PA, 2006
Cohen MA, Goforth HW, Lux JZ, Batista SM, Khalife S, Cozza KL, and Soffer J. Handbook of AIDS Psychiatry. Oxford University Press, New York, New York, 2008
Cohen MA, Goforth HW, Lux JZ, Batista SM, Khalife S, Cozza KL, and Soffer J. Handbook of AIDS Psychiatry. Oxford University Press, New York, New York, 2010

15. Other Relevant Books by Members and Countless Chapters and Articles
Treisman GJ and Angelino AF. The Psychiatry of AIDS – A Guide to Diagnosis and Treatment. The Johns Hopkins University Press, Baltimore, Maryland, 2004
Bourgeois JA, Kahn D, Philbrick KL, Bostwick JM. Casebook of Psychosomatic Medicine. APPI, Arlington, Virginia, 2009
Wynn GH, Oesterheld JR, Cozza KL, Armstrong SC.
Clinical Manual of Drug Interaction Principles for Medical Practice. APPI, Arlington, Virginia, 2009

16. Goals Reached We have presented annually at the APM
We have presented several times at the APA in collaboration with the APA Office of HIV Psychiatry
We have shared our slide sets with mental health clinicians in underserved areas of the US and worldwide
We have published our work
We have become a section of the WPA
We now have over 300 members

17. New Directions
In February 2012 thanks to the support of APM HIV SIG Members Maria Ferrara, MD and the encouragement and work of Pedro Ruiz, MD, who is now WPA President, our SIG became the 66th Section of the WPA
We are now applying to become a SIG of the European Academy of Psychosomatic Medicine with the help of members Maria Ferrara, MD and Silvia Ferrari, MD
We would like to become active in the International AIDS Society
We plan to present at future meetings of the WPA

18. How Can We Decrease Transmission of AIDSism and HIV?
Teach sexual history-taking to trainees and faculty
Teach drug history-taking to trainees and faculty
Diagnose and treat neurocognitive disorders
Diagnose and treat substance use disorders
Diagnose and treat other multimorbid psychiatric disorders such as PTSD and depression
Educate and encourage use of barrier contraception for sexually active patients
Make free condoms openly available in ambulatory and inpatient medical and psychiatric settings, day treatment programs, MMTPs, and drug rehabilitation facilities
Cohen MA. AIDSism, a new form of discrimination.
AMA News, January 20, 1989; 32:43

19. HIV/AIDS: A Paradigm for Comprehensive and Compassionate Care with a Biopsychosocial Approach
Complex and severe medical and psychiatric illness
Persons with HIV/AIDS are vulnerable
Medically
Psychiatrically
Socially
Cohen MA and Gorman JM. Comprehensive Textbook of AIDS
Psychiatry. Oxford University Press, New York, 2008
Cohen MA, Goforth HW, Lux JZ, Batista SM, Khalife S, Cozza
KL, and Soffer J. Handbook of AIDS Psychiatry. Oxford
University Press, New York, 2010.

20. HIV/AIDS Psychiatry Lethality Severe Multisystem Taboo Illness Topics
Cardiac
Dermatological
Endocrinological GI
Infectious
Neurological
Oncological
Ophthalmologic
Psychiatric
Pulmonary
Renal
Stigmatized Illness
Hepatitis C STDs TB
PTSD Dementia Delirium
Psychosis Injecting Drug Use
Sex
Trauma
Drugs
Infection
Death
Prevention
HIV/AIDS
Psychiatry
Barrier contraception
Drug treatment
Safe sex
Sterile works
Trauma prevention
Lethality
Adherence to Prevention and Treatment
Men who
have sex
with men
African-
American
Latino-
American
Addicted
Children
Elderly
Women
Vulnerable Populations

21. HIV/AIDS Psychiatry Stigmatized illnesses Vulnerable populations
Stigmatized populations
High prevalence of psychiatric disorders
Multidisciplinary team approach
Comprehensive, and compassionate care
Integrated model of care with psychiatrists
co-located in the HIV clinic

22. Need for Recognition and Treatment of Psychiatric Disorders
Vectors of HIV
Barriers to adherence
Psychiatric treatment:
 transmission, morbidity, mortality, suffering
 adherence

23. Multimorbid and Diagnostic Complexities in Persons with HIV/AIDS
Freedman JB, O’Dowd MA, Wyszynski B, Torres JR, McKegney FP. Depression, HIV dementia, Delirium, Posttraumatic Stress Disorder (or all of the above). General Hospital Psychiatry 1994; 16: Many of our patients have multimorbid psychiatric and medical illnesses with complex histories, elements of trauma, as well as complicated courses and treatments.

24. The Role of Collaborative Care in the HIV Pandemic
Prevention
Can promote adherence to:
safe sex
drug treatment
harm reduction
needle exchange
Treatment
Can improve adherence to:
medical care
antiretrovirals
Can decrease:
suffering
morbidity
mortality

25. Academy of Psychosomatic Medicine HIV/AIDS Psychiatry SIG
Founded 2003, meets annually
To develop networks
To present work and share findings
To develop consensus on treatment
To develop collaborative research
To educate other clinicians and trainees
Has over 300 mental health clinician members
to join – no dues