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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
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WPA Prague Section Chairs Meeting
October 20, 2012
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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:
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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Need for Recognition and Treatment of Psychiatric Disorders
Vectors of HIV Barriers to adherence Psychiatric treatment: transmission, morbidity, mortality, suffering adherence
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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.
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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
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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
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