Triple Diagnosis: Dual Diagnosis and HIV Disease, Part 1
Triple Diagnosis: Dual Diagnosis and HIV Disease, Part 1
Substance use disorders and psychiatric illness commonly co-occur in what is known as dual diagnosis. With the spread of HIV infection in persons with dual diagnoses, the triple diagnosis has emerged as a clinically challenging condition for primary care physicians, addiction medicine specialists, and psychiatrists. Existing data support the high prevalence of triple-diagnosis patients in psychiatric, substance abuse, and HIV treatment settings. This review highlights the features of substance abuse-psychiatric illness and its association with changes in antiretroviral therapy use, adherence, and HIV treatment outcomes. An integrated and interdisciplinary approach addressing substance abuse and mental health issues should be a primary element of comprehensive HIV care. Evaluating the safety and efficacy of psychopharmacologic and psychotherapeutic interventions and understanding the complex interactions among the components of the triple diagnosis are areas for future research. Service delivery and intervention models based on "1-stop shopping" should be developed and put into practice in order to optimize clinical outcomes.
Health care professionals have increasingly recognized the dual diagnosis of coexisting substance use and psychiatric disorders. The triple diagnosis of HIV infection with psychiatric and substance use disorders has emerged as a clinical condition creating a unique and complex set of medical and psychosocial challenges. Patients with triple diagnosis have complicated presentations on multiple levels, including poor adherence to medical treatment and worsening of substance abuse and psychological distress. The purpose of this review is to discuss current knowledge about the coexistence of dual diagnosis and HIV infection and to suggest management strategies. The prevalence of this diagnosis is reviewed and then the medical, psychiatric, and substance abuse issues in the context of the triple diagnosis are discussed, emphasizing an integrated approach to treatment. Finally, an outline of directions for future research with respect to the triple diagnosis is presented.
Substance use disorders and psychiatric illness commonly co-occur in what is known as dual diagnosis. With the spread of HIV infection in persons with dual diagnoses, the triple diagnosis has emerged as a clinically challenging condition for primary care physicians, addiction medicine specialists, and psychiatrists. Existing data support the high prevalence of triple-diagnosis patients in psychiatric, substance abuse, and HIV treatment settings. This review highlights the features of substance abuse-psychiatric illness and its association with changes in antiretroviral therapy use, adherence, and HIV treatment outcomes. An integrated and interdisciplinary approach addressing substance abuse and mental health issues should be a primary element of comprehensive HIV care. Evaluating the safety and efficacy of psychopharmacologic and psychotherapeutic interventions and understanding the complex interactions among the components of the triple diagnosis are areas for future research. Service delivery and intervention models based on "1-stop shopping" should be developed and put into practice in order to optimize clinical outcomes.
Health care professionals have increasingly recognized the dual diagnosis of coexisting substance use and psychiatric disorders. The triple diagnosis of HIV infection with psychiatric and substance use disorders has emerged as a clinical condition creating a unique and complex set of medical and psychosocial challenges. Patients with triple diagnosis have complicated presentations on multiple levels, including poor adherence to medical treatment and worsening of substance abuse and psychological distress. The purpose of this review is to discuss current knowledge about the coexistence of dual diagnosis and HIV infection and to suggest management strategies. The prevalence of this diagnosis is reviewed and then the medical, psychiatric, and substance abuse issues in the context of the triple diagnosis are discussed, emphasizing an integrated approach to treatment. Finally, an outline of directions for future research with respect to the triple diagnosis is presented.
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