October 31, 2002
"We can't assume there are enough specialists to handle it," said Ken Citron, who runs the HIV psychiatric clinic at Mount Sinai Hospital in Toronto. Citron says general psychiatrists are going to have to develop a working knowledge of how to treat HIV patients. He says psychiatric residency training should include some exposure to HIV/AIDS issues -- often not the case outside large Canadian centers.
People with HIV have a higher incidence of mental health problems than the general population. HIV attacks the brain, causing inflammation and tissue deterioration. The illness also causes several neuro-cognitive disorders that can lead to clinical depression. Many people with HIV also have mild or moderate thinking problems, process more slowly, and have trouble with memory and focus. Citron notes that treatment requires a certain amount of specialized knowledge because of the interaction between psychiatric and HIV drugs.
As HIV becomes more of a chronic illness, the mental strain of living with the disease creates other needs. "We have to help them find meaning and develop relationships that will enable them to live with the illness," said Citron. "Even if you treat that person's major depression, there's still a human being there with all sorts of needs and concerns," he said. "Work-related issues: 'Do I go back to work and risk losing disability benefits and then getting fired?' And then what happens if the illness flares up?"
10.30.02; Judy Monchuk