SCREENING FOR PSYCHIATRIC MORBIDITY IN A MEDICAL OUTPATIENT-CLINIC FOR HIV-INFECTION - THE NEED FOR A PSYCHIATRIC PRESENCE

Objective: To ascertain the prevalence and type of psychiatric morbidi ty present in HIV infected patients presenting for the first time to a specialty HIV medical clinic. Also, to develop a way of screening for psychiatric cases in this setting using established self-report quest ionnaires. Method: Fifty patients who presented consecutively for medi cal care at the Johns Hopkins Hospital General HIV Clinic participated in this study. These patients were first screened using the General H ealth Questionnaire and the Beck Depression Inventory and subsequently underwent a comprehensive neuropsychiatric evaluation. Results: Fifty -four percent were found to suffer from a psychiatric disorder with an additional 22 percent from an active substance use disorder.These rat es are one-and-one-half to two times higher than those reported from o ther medical clinics. The GHQ and BDI used together as screens could i dentify psychiatric ''cases'' with a sensitivity of 81 percent and a s pecificity of 61 percent, an efficacy similar to that found in other c linics. Conclusions: Given the high prevalence of psychiatric disorder s in HIV infected patients presenting for medical care, screening, eva luating, and treating for these disorders is crucial and should be pur sued systematically. This is best done through the presence of a psych iatric team within HIV medical clinics rather than in affiliation with such clinics.