Book Review: HIV and Psychiatry: HIV and Psychiatry: A Training and Resource Manual

Abstract

HIV and Psychiatry: A Training and Resource Manual Kenneth Citron, Marie-Josee Brouillette, Alexandre Beckett, editors. 2nd edition. New York (NY): Cambridge University Press; 2005. 346 p. US$65.00. Reviewer rating: Excellent Review by Raymond Tempier, MD Saskatoon, Saskatchewan Human Immunodeficiency Virus (HIV) was first reported to be associated with AIDS in 1984. Since then, HIV has caused the worst worldwide epidemic in recent times and HIV infection is still progressing. At the end of 2005, according to the Public Health Agency of Canada, 58 000 Canadians were infected with HIV, a 16% increase since 2002.' The prevalence rate of HIV infection is also increasing as patients stay alive owing to treatment progress, but many (27%) ignore that they are infected. HIV infection is affecting psychological health but is also related to mental illness. It is now well known that HIV damages the brain, as 10% to 20% of infected individuals have some cognitive impairment. As we all know, HIV infection is devastating in sub-Saharan Africa, and in a recent study in Uganda, researchers found that, in a cohort of patients hospitalized for manic episode, 55% were HIV positive.2 These findings are consistent with the hypothesis that HIV infection can lead to the development of secondary mania.3 Such results are examples of the dramatic impact that HIV infection has on psychiatric disorders. This training manual comes at quite an opportune time as HIV infection and its consequences on mental health are still burning issues to deal with. My review is of the second edition of this training manual, which was prompted by the availability of new treatments such as antiretroviral medications and, most recently, highly active antiretroviral therapy. These drugs have changed the prognosis of HIV-infected patients. Nevertheless, azidothymidine (AZT) and related medications are heavy treatments requiring strict adherence to the treatment schedule; as well, they interact with psychotropic medications. As shown before, several mental disorders, not only cognitive deficits, are related to HIV infection. Therefore, this book aims to present the knowledge base necessary for psychiatrists and mental health professionals to better help, support, and treat those infected with HIV and its effects on mental health. The book starts with an extensive medical overview of the HIV infection. Practical tables show necessary baseline laboratory tests. A summary table lists the neuropsychiatrie side effects of medications used to treat HIV infection. This first chapter is also filled with details on antiretroviral therapies and their relation to psychotropic medications. The lipodystrophy syndrome, a consequence of antiretroviral therapy, is presented here through several pictures that are, unfortunately, of rather poor quality. The suggested websites are a useful addition to this basic information. The second chapter focuses on cognitive disorders that are becoming a common complaint of HIV patients, according to the authors. We also learn that up to 25% of patients have some sort of minor cognitive motor disorder. In each chapter of this book, there is a primary case history, with the chapter structured according to the pertinent questions that could arise for a practising physician faced with such a situation. …