Psychosomatics 39:80-81, February 1998
© 1998 The Academy of Psychosomatic Medine
Psychiatric Comorbidity in HIV and AIDS
Sean Lynch, MBChB, MRC Psych, Senior Lecturer in Psychiatry, University of Leeds, and
Ram Seth, MBBS, MRC Psych, Consultant Psychiatrist, St. Mary's Hospital, Isle of Wright, United Kingdom
Key Words:
TO THE EDITOR: We were interested to read the editorial "Depressive Syndromes and Causal Associations" by Lyketsos and Treisman1 and the article "Psychiatric Comorbidity Among Hospitalized AIDS Patients vs. Non-AIDS Patients Referred for Psychiatric Consultation" by Bialer et al.,2 and we would like to comment on the authors' interpretation of findings published in our paper.3
Our paper deals with clinical diagnoses made by the liaison psychiatrist at initial assessment of patients who are infected with the human immunodeficiency virus (HIV) and those who have the acquired immune deficiency syndrome (AIDS), according to the International Classification of Diseases–9th Revision (ICD-9) diagnostic criteria. This initial diagnosis would be made by excluding known iatrogenic causes of psychiatric symptomatology and other physical conditions related to HIV and AIDS. All patients who were referred had been thoroughly assessed by a physician from the Department of Infectious Diseases or Genitourinary Medicine at St. Mary's who was either a consultant or senior registrar. We believe that our article emphasizes the prevalence of affective syndromes in this group of patients who were referred, but actually our article highlights the difficulties in making an accurate initial clinical diagnosis.
Not all of the patients were routinely investigated by imaging, and some cases of cryptogenic infection that came to light at a later stage caused revision of the original clinical diagnosis. Our article addresses some of the selection biases operating on our sample and the limitations of ICD-9 diagnostic system (then used in the United Kingdom) in this patient group rather than attempting to "defend" the original clinical diagnosis. We would agree that these original diagnoses would not have been valid in a number of patients because of later physical findings, as is discussed in our paper.
We wholeheartedly support the need for further, more rigorous assessment of psychiatric comorbidity in hospitalized HIV patients, as mentioned by Bialer et al.,2 but we would emphasize that the difficulties we described in making accurate initial diagnoses need further research in this patient group. Nosological issues in this group pose particular challenges, and we feel that research in this area needs to encompass longitudinal rather than cross-sectional methodology to address these issues.
REFERENCES
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Lyketsos CG, Treisman GJ: Depressive syndromes and causal associations. Psychosomatics 1996; 37:407–412[Free Full Text]
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Bialer PA, Wallack JJ, Prenzlauer SL, et al: Psychiatric comorbidity among hospitalized AIDS patients vs. non-AIDS patients referred for psychiatric consultation. Psychosomatics 1996; 37:469–475[Abstract/Free Full Text]
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Seth R, Granville-Grossman K, Goldmeier D, et al: Psychiatric illnesses in patients with HIV infection and AIDS referred to the liaison psychiatrist. Br J Psychiatry 1991; 159:347–350[Abstract/Free Full Text]
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