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Book Forum: Neuropsychiatry   |    
Practitioner’s Guide to the Neuropsychiatry of HIV/AIDS
CONSTANTINE G. LYKETSOS, M.D., M.H.S.
Am J Psychiatry 2000;157:475-475. doi:10.1176/appi.ajp.157.3.475
View Author and Article Information
Baltimore, Md.

edited by Wilfred G. van Gorp, and Stephan L. Buckingham. New York, Guilford Publications, 1998, 280 pp., $35.00.

Almost two decades have passed since the emergence of a new disease that involves the brain in several ways, namely, HIV/AIDS. Great strides have been made in the understanding of the neuropsychiatric complications of this infection, which include cognitive disorders, dementia, mood disorders, psychotic disorders, and bereavement. In addition, there has been great progress in our ability to care for patients with these conditions (1). Therefore, the time is ripe for a comprehensive book geared toward the "non-neurologically trained mental health clinician." This is precisely the gap that this book is attempting to fill.

Attractive and nicely bound, the volume consists of 10 chapters. The first four, although of varying titles, have very similar content. They are reviews or syntheses of current knowledge on the spectrum of the neuropsychiatric consequences of HIV infection. The first chapter, "The Neuropsychological Features of HIV Disease" by Hinkin et al., is rather comprehensive. Its great strength is a detailed discussion of the various neuropsychological changes associated with HIV infection and their clinical relevance. However, this chapter and the following three are highly repetitive in presenting current knowledge on mood disorders, psychosis, motor disorders, and other neuropsychiatric features of HIV disease. In addition, the four chapters either are selective in what information they reference or interpret the same information in somewhat contradictory ways. Chapter 4, by Sciolla et al., is the best written and most complete discussion of the noncognitive neuropsychiatric complications of HIV disease.

The chapters that follow are focused on interventions. The focus of the chapter on "Pharmacological Interventions" is on the cognitive disorders; it contains little useful information on the pharmacological treatment of other neuropsychiatric conditions. The next chapter, "Psychosocial Interventions," is more clinically relevant and quite useful in its discussion of supportive, psychotherapeutic, and other psychosocial interventions. However, most of the interventions discussed have relevance for gay men and are less applicable to other populations affected by HIV, such as injection drug users. Chapter 7 focuses on the caregivers of individuals with HIV disease and ways to help them; it does a reasonable job in addressing this topic. It is followed by an excellent review of "Suicide and HIV Disease," probably the strongest chapter in the volume. Next are chapters on "Ethical and Legal Issues" and "Enhancing Adaptive Functioning of Cognitively Impaired Patients With HIV Disease." Both of these contain interesting information; however, similar discussions have been published in a variety of other settings, and the ones in this book do not add much new insight.

Overall, van Gorp and Buckingham’s book contains some good discussions of the neuropsychiatric features of HIV disease. However, the information is often repetitive, and the writing is at times dense. Where the volume clearly fails is in not presenting an overarching approach to the neuropsychiatry of HIV infection. Rather, it is a collection of disparate, often repetitive papers. It also fails to present the relevance of the knowledge contained in the volume to day-to-day clinical practice, one of the stated goals of the book. For example, although some of the chapters include case discussions that are quite insightful, this approach is rather sparsely used overall and ignored in most chapters. As a result, the volume is more encyclopedic than of everyday usefulness to the practitioner. It is probably of greater interest to mental health professionals who are actively involved in the care of HIV-infected patients and who have a variety of academic interests as well than to the "non-neurologically trained mental health practitioner."

Lyketsos CG (ed): The Psychiatry of HIV Infection. Int Rev Psychiatry 1996; 8(2/3)
 
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References

Lyketsos CG (ed): The Psychiatry of HIV Infection. Int Rev Psychiatry 1996; 8(2/3)
 
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