AIDS, HIV and Mental Health
AIDS, HIV and Mental Health
Michael B. King
New York NY: Cambridge University Press, 162 pp., 1993
ISBN 0 521 45294 (hardcover)
It is a pleasure to read AIDS, HIV and Mental Health by Michael B. King M.D., AIDS liaison psychiatrist at the Royal Free Hospital School of Medicine, London, UK. Published in 1993, this short book contains an excellent critical review of the relevant literature reported in this rapidly growing field through 1992. One of the distinguishing features of this text is Dr. King’s efforts to include studies from around the world, thus giving the reader a greater global perspective.
The text begins with a short medical overview of HIV disease and then moves into chapters on psychiatric disorders that develop over the course of HIV disease. There is an excellent discussion of predictive and protective factors associated with the development of psychiatric disorders that is clinically useful in evaluating which patients are at greatest risk for the development of a clear psychiatric disorder requiring psychiatric intervention. There is an excellent critical analysis of the complex relationship between stress, psychological morbidity and immunity which argues against often made simple explanations of their interplay and points out the limitations of many of the studies conducted in this field. The discussion of suicide and assisted suicide is coherent and thoughtful and draws on studies from the UK, US, Sweden and the Netherlands. Particularly informative is the review of some of the shortcomings in the practical implementation of the euthanasia legislation in the Netherlands which will be useful to other countries grappling with legislation in this controversial area. The chapter on neuropsychiatric manifestations of HIV disease is solid and usefiil to the clinician interested in the predictive power of diagnostic tests used in the evaluation of HIV-related cognitive impairment and noteworthy for pointing out the limitations of our understanding in this complex area. There are excellent chapters on sexual behavior and illicit drug use with an important discussion of the limitations of education on behavior change in the absence of addressing psychological variables and the consequences of substance related disorders. The work is inclusive and it is refreshing to see a discussion of behavior change that not only includes homosexual and bisexual men and heterosexual women, but also addresses the issues faced by prisoners and sex workers.
The sections on interventions are not as strong as the sections on epidemiology and clinical descriptions of neuropsychiatric and psychiatric disorders. In part, this may reflect the limited number of published studies reporting on psychiatric interventions. The discussion of psychopharmacology highlights all areas but lacks sufficient detail. However, it does establish a solid base which can be augmented by referring to the current HIV psychiatric literature which has seen a significant increase in intervention studies over the past two years. A discussion of theoretical strategies currently under investigation to slow down the progression of cognitive impairment would be a useful addition to the neuropsychiatry chapter so that clinicians could become familiar with neuroprotective agents that may become a reality in the near future. The discussion of psychotherapeutic and counselling techniques is also limited but contains an interesting description of studies from Zambia, Zaire and Uganda which highlight the need for culturally sensitive interventions.
What makes this one of the best texts in the field is the writing of Dr. King who gives a comprehensive, balanced, critical analysis of the reported literature supported by his valuable clinical impressions in areas where studies are lacking. He is able to write about the complexities of human behaviors in a calm and thoughtful manner and he has an ability to use science in a sensitive manner to guide his practice. The book is an easy read and should be on the curriculum for medical students and house staff. Family physicians, psychiatrists and nonpsychiatric mental health workers will find this to be an excellent reference to consolidate their knowledge base and it is hoped that they will be stimulated by the excellent appraisal of the literature to answer some of the important research questions that the author has generated.