WASHINGTON--For the first time ever, the American Psychiatric Association (APA) is working to establish treatment guidelines for an illness that is primarily medical, but that has psychiatric complications. At the association's annual meeting in Washington, D.C., this week, an APA workgroup will submit the first draft of Practice Guidelines for the Treatment of Persons with HIV Infection and AIDS it plans to publish for national dissemination in 2000.
Over the past 10 years, the APA has published numerous practice guidelines for conditions such as major depression, schizophrenia and Alzheimer's disease, but never for a primarily medical illness. The new guidelines will mark the first national effort to establish the standard of psychiatric care for persons affected by HIV and AIDS.
The workgroup comprises national experts from institutions including Emory University, Brown University, Columbia University, Harvard Medical School, University of Miami School of Medicine, Johns Hopkins University and Georgetown University in the area of clinical management of neuropsychiatric, psychiatric and psychosocial treatment of persons with HIV/AIDS. Stephen McDaniel, M.D., Emory University associate professor of psychiatry and behavioral sciences, chairs the workgroup. Dr. McDaniel is founder and director of mental health services at the Ponce de Leon Center, one of the largest and most comprehensive outpatient HIV treatment facilities in the country, jointly operated by Emory University School of Medicine and Grady Memorial Hospital. Located in midtown Atlanta, the center serves nearly 4,000 patients infected with HIV. In 1995 the APA awarded the center's mental health program its highest award for clinical service delivery, the Gold Achievement Award.
"This is an important move for the APA to endorse practice guidelines for persons with HIV/AIDS," says Dr. McDaniel. "Although the APA has provided national leadership for the past 10 years through its Commission on AIDS, part of the impetus for these guidelines is the realization that few of us have been untouched by HIV/AIDS. Psychiatrists are in a unique role to counsel patients about sexual behaviors and drug use behaviors and can play a significant role in both primary and secondary prevention. Psychiatrists also are in the very best position to treat HIV-related neuropsychiatric complications such as depression, anxiety and dementia.
"Hopefully, the practice guidelines will further empower psychiatrists to take an even more active role in treating HIV-positive patients and in incorporating aspects of HIV risk behaviors into their assessments and treatment plans, says Dr. McDaniel."
He believes the new recommendations will undoubtedly improve the overall care of persons with HIV by focusing on access to care, treatment adherence, education, prevention and direct mental health services. As HIV-positive individuals live longer lives, the likelihood of a general psychiatrist working with an HIV-positive person is much higher than in the past, he points out.
At the Emory/Grady Ponce de Leon Center, mental health is a basic component of comprehensive patient care. "We try to diminish obstacles such as referring patients outside the system and we try to treat them here as a whole person -- body and mind. We work with patients covering the entire spectrum, including those who have difficult reactions to finding out they are HIV positive, to those struggling with living with HIV infection, to those at the end of life with numerous neuropsychiatric complications.