As in any population suffering from chronic illness, HIV-positive patients often experience mental health problems.¹²⁵ In order to determine if a change in mental status stems from a pre-existing medical or psychiatric disorder or is caused by HIV or an OI, any acute or chronic change in mental status must be evaluated immediately.

Depression is a common reaction to the diagnosis of a life-threatening and stigmatizing disease such as AIDS. Economic stressors and social upheaval, which may worsen once the patient falls ill, are often the very situations that put people at risk for HIV infection. Depression can be debilitating and should never be discounted as a “normal” reaction to diagnosis or progression of disease.¹²⁶ Rather, depression should be treated with counseling and selective serotonin re-uptake inhibitors (SSRIs) or other antidepressants, when available. Anxiety is also common among HIV-positive patients and should be treated after biological causes have been ruled out. Other mental health disorders that are not more common in HIV-positive persons—such as schizophrenia and bipolar illness—should also be considered and, if diagnosed, treated.¹²⁷

Psychosocial issues affecting HIV-positive patients and their families are often overlooked by providers but should in fact be addressed as part of a comprehensive treatment plan.^128,129 Although Table 3.9 divides the occurrence of these issues into early, middle, and late phases, any of these issues may present during any stage of disease progression.

Table 3.9 Psychological and Psychosocial Issues

Early after HIV diagnosis – Adjusting to new diagnosis of HIV seroconversion; acute vs. chronic adaptational responses (fear of imminent death, guilt over infecting others, exacerbation of existing psychiatric conditions, acute suicidal ideation) – Disclosure to others; informing intimate contacts, partners, children – Adopting safer sexual behaviors – Accessing medical and psychiatric care – Defining those involved in the care of the patient Middle phase – Adjusting work and family needs to physical and emotional impact of illness – Learning about the nature of the illness and the potential treatments – Adherence to medication – Decisions about working and providing for family – Maintaining relationships and managing normal developmental issues in the context of the uncertainty of the progression of illness< – Dealing with untoward effects of illness and/or treatment (fatigue, medication side effects, etc.) Late phase – Planning for care of family members – Decisions about end of life and preparations for death

Source: Forstein M. Psychiatric problems. In: O’Neill JF, Selwyn PA, Schietinger H, eds. A clinical guide to supportive and palliative care for HIV/ AIDS. United States Department of Health and Human Resources, Health Resources and Services Administration, 2003:207–52.