Mental health issues and HIV/AIDS: HIV-specific screening and treatment tools for mood disorders

Katherine MurrayMental Health, Rapid Responses, Substance Use

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Questions

Are there HIV-specific screening tools for the mood disorders including Depression, Anxiety disorders, Adjustment Disorder or Substance Abuse Disorders?

Are there specific recommendations on appropriate treatment or treatment tools of mood disorders and substance abuse disorders in people with HIV, in general, prescribing medication and/or physical therapy?

 Key take-home messages

  • HIV-specific screening and treatment tools for substance abuse and mood disorders have not been developed. The following are primarily recommendations from experts in the HIV field.
  • Physical symptoms of depression are difficult to distinguish from the physical manifestations of HIV, except perhaps to physicians with a particular expertise in serving people with HIV. Following an initial screen, using the PHQ-9 noted above, physicians and professionals without an expertise in HIV infection should consider seeking consultation or refering to a specialist.
  • With the exception of depression, mood disorders and substance abuse disorders among people with HIV are poorly addressed in the literature.
  • Significant additional research is necessary to investigate the interactions of psychopharmacology and HAART

The issue and why it’s important

As treatment protocols for people with HIV become increasingly sophisticated, clinicians and medical professionals are seeking guidance in identifying and addressing concurrent diagnoses such as mood disorders and substance abuse disorders. Distinguishing between physical manifestations of HIV infection and physical symptoms of mental health challenges can be difficult as can simultaneously treating multiple physical and mental health concerns. A primary care physician has requested assistance reviewing the literature for screening tools, treatment protocols and best practices for people with HIV who also have mood or substance abuse disorders.

What we found

Depression

Screening:

  • It has been noted that physical symptoms of depression can be challenging to distinguish from symptoms of HIV so a focus on cognitive and affective symptoms is advocated.1 Loss of libido, fatigue, hypochondriasis and weight loss have been found to be poor discriminators between depressed and not depressed people with HIV. (1)
  • The Adding Life to Years project advocates using the Patient Health Questionnaire (PHQ-9) as an initial screen for depressive symptoms, especially useful for frontline workers. (2)
  • Experts in the field additionally support use of the Montgomery-Asberg Depression Scale (MADRS) as it does not rely on physical symptoms (as do other instruments such as the Beck Depression Inventory and HDMA). (4)

Treatment

 

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Reference list

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Suggested citation

Rapid Response Service. TITLE. Toronto, ON: Ontario HIV Treatment Network; MONTH, YEAR.

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