AFISE Psychiatric Symptomatology among Patients with HIV
#PO3/08
Psychiatric Symptomatology
among Patients with HIV and Hepatitis C –
the experience of a Romanian clinic
Background
Depression is considered as one key determinant of health outcomes for patients with chronic infectious diseases
such as HIV and hepatitis C. For example, it can influence the patient’s ability to adhere with the treatment and
various behaviors or it can be associated with engagement in high risk behaviors . Depressive symptomatology can
be secondary to biological changes ( for example during the interferon based treatment for patients with hepatitis
C) or it can be secondary to the psychological impact of being sick. Regardless of its cause, due to its impact on the
health outcomes,routinely screening patients for depressive symptoms is recommended by many guidelines and best
practices.
Information about the setting: Baylor clinic is situated in Constanta, Romania and it is taking care of approximately
1000 patients with HIV and 300 active cases with hepatitis C. Taking into consideration the above background, our
team decided to assess if depressive symptomatology is common among our patients as well. A partnership with a
psychiatrist was established, therefore, a psychiatric evaluation would follow the rapid screening and treatment would
be instituted if needed.
Objectives To identify the prevalence of depressive symptomatology among long term survivors living with HIV (PLWHA) and
among the patients recently diagnosed with hepatitis C virus (PCHC) enrolled into care at Baylor Clinical Centre
during the year 2015; and to assess the need for mental health care services (psychological support, psychiatric care)
among those at risk for depression.
Methods The Hamilton Depression Inventory (HDI), Romanian version was used in
order to screen 349 adult PLWHA (average age 26.7 years old) and 128 PCHC
(average age 54.5 years old) that were in the care of the clinic psychosocial team
at the time of the assessment. Patients were dichotomized on whether they had
high HDI scores and needed referral for a psychiatric evaluation or low scores
and were not referred.
Results PLWHA have been in care for an average of 9.8 years, while PCHC were
generally new cases (enrolled in average for 2 months). 29% (37) PCHC and 4%
PLWHA (13) were referred for further psychiatric evaluation. As a result of the
assessment, 12 PCHC were diagnosed with adjustment disorder with depressed
mood, or with depressive episode, and received treatment, while 25 PCHC were
recommended psychological support; all PLWHA referred were diagnosed with
various psychiatric disorders and 10 received medication.
Conclusion HDI is a convenient screening tool. Mental health screening should be included in standard care procedures. Newly
enrolled PCHC might be at higher risk due to both challenges associated with adjustment to a new diagnosis and
the linkages reported in the literature about the effect of hepatitis C virus on the brain. PLWHA who had been
diagnosed a decade ago have significantly lower rates of depressive symptomatology. A liaison psychiatrist is a
valuable addition to the multidisciplinary team that cares for patients with HIV and hepatitis at the Baylor clinic.
Authors
AM Schweitzer,
M Bogdan,
L Vlahopol,
I Radulescu,
S Stanciu,
C Pop