Psych Vivas · Consultation-liaison psychiatry
HIV psychiatry — structured clinical viva
Fellowship viva covering Frascati HAND, CHARTER, CBT-AD/Pence depression care, efavirenz, booster interactions, stigma, suicide, and Appelbaum capacity.
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Reveal interpretationShowHide
Open with a multi-axial map. Hold major depression, possible HAND (need function + testing), efavirenz CNS toxicity, adherence failure, stigma, and capacity as concurrent tasks — not a single label war.[1][5][9]
HAND literacy. Name Frascati ANI/MND/HAD; everyday interference separates ANI from MND/HAD. CHARTER: impairment persists in ART era, often milder.[1][2]
Depression–adherence. Cite Gonzalez nonadherence link; offer measurement-based antidepressants (Pence) and CBT-AD (Safren).[3][4][9]
Efavirenz. Nightmares/insomnia/psych toxicity — discuss switch with HIV team while keeping ART continuous.[5]
Interactions. Boosters + quetiapine = classic toxicity trap; check every psychotropic.[6]
Stigma and suicide. Stigma worsens mental health outcomes (Rueda); suicide risk factors elevated in PLHIV (Smith) — safety plan.[7][10]
Capacity. Decision-specific Appelbaum assessment for investigations/regimen; treat reversible contributors and reassess.[8]
References10ShowHide
- [1]Antinori A, Arendt G, Becker JT, et al. Updated research nosology for HIV-associated neurocognitive disorders Neurology, 2007.PMID 17914061
- [2]Heaton RK, Clifford DB, Franklin DR Jr, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study Neurology, 2010.PMID 21135382
- [3]Safren SA, O'Cleirigh C, Tan JY, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals Health Psychol, 2009.PMID 19210012
- [4]Pence BW, Gaynes BN, Adams JL, et al. The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial AIDS, 2015.PMID 26134881
- [5]Kenedi CA, Goforth HW A systematic review of the psychiatric side-effects of efavirenz AIDS Behav, 2011.PMID 21484283
- [6]Goodlet KJ, Zmarlicka MT, Peckham AM Drug-drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs CNS Spectr, 2019.PMID 30295215
- [7]Rueda S, Mitra S, Chen S, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses BMJ Open, 2016.PMID 27412106
- [8]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [9]Gonzalez JS, Batchelder AW, Psaros C, et al. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis J Acquir Immune Defic Syndr, 2011.PMID 21857529
- [10]Smith A, Breazeale S, Goulet JL, et al. A Systematic Review of Risk Factors for Suicide Among Persons Living with HIV (1996-2020) AIDS Behav, 2022.PMID 35107660