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Book Reviews   |    
The Psychiatry of AIDS: A Guide to Diagnosis and Treatment
Reviewed by Francine Cournos, M.D.
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.2.277-a
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by Glenn J. Treisman, M.D., Ph.D., and Andrew F. Angelino, M.D.; Baltimore, Johns Hopkins University Press, 2004, 217 pages, $19.95 softcover

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The Psychiatry of AIDS: A Guide to Diagnosis and Treatment is a lively book written by two Johns Hopkins psychiatrists with extensive HIV-AIDS experience. The book's primary focus is the clinical management of patients with complex needs who have HIV infection, substance use disorders, and other mental illnesses, although the entire gamut of the neuropsychiatric manifestations of HIV is covered.

The book opens with a series of revelatory quotes from the authors' clinical experience at an HIV clinic that capture the essence of working with patients who have multiple diagnoses—for example, "Thank you for saving my life, Dr. Treisman. Can I have a dollar?"; "Drug treatment is a good concept, but it doesn't work for me"; and "My way might be crazy, but it's how I've always done it." Nine equally lively chapters follow, interspersed with case presentations. The chapters discuss patients with HIV infection who also suffer from major depression, dementia, psychosis, personality disorders, substance abuse, chronic pain, sexual dysfunction, or any mixture of these or other HIV-related mental health problems. Glenn J. Treisman, M.D., Ph.D., is known for his ability to engage an audience in the management of challenging patients, and he and his coauthor, Andrew F. Angelino, M.D., invite the reader to learn these techniques.

A limited number of psychiatrists have developed specific expertise in working with HIV-infected patients, and mental health services in most AIDS medical settings are limited. For these reasons, health care providers are often on their own when managing patients with HIV infection who present with psychiatric disturbances. The Psychiatry of AIDS will be highly accessible to that audience. It is practical and down to earth, highlighting strategies that can be used by a broad array of practitioners to engage and retain patients, improve cooperation with medical care, and provide biopsychosocial treatment, including psychotherapy and pharmacologic management, for substance use disorders and other psychiatric illnesses commonly seen among AIDS patients.

The authors are well versed in the literature, but they also have strong opinions about what is truly helpful. So, for example, when discussing personality they focus primarily on the two dimensions of extraversion-introversion and stability-instability. They do not find the DSM-IV categories of personality disorder to be particularly useful and place little emphasis on psychoanalytic concepts of psychopathology. Although some psychiatrists will take issue with these views, on a practical level, when dealing with the "reward-sensitive and punishment-insensitive" patients with substance abuse who are often seen in HIV clinics in the United States, this way of conceptualizing personality fosters realistic and compassionate strategies for working with people who are often rejected in medical settings.

The Psychiatry of AIDS is practical, accessible, and engaging. Not all readers will agree with the authors' theoretical emphases, but almost every reader will find useful techniques to apply in treating psychiatrically complex patients who have HIV infection.

Dr. Cournos is chair of the American Psychiatric Association's committee on AIDS and professor of clinical psychiatry at Columbia University in New York City.




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