AIDS policy: guidelines for inpatient psychiatric units

The HIV-positive psychiatric patient and the duty to protect: ethical and legal issues

A small, yet significant, percentage of HIV-positive patients have a concomitant psychiatric or neurological disorder associated with impaired judgment. Clinical problems such as psychoses, certain personality disorders, and dementias are associated with disinhibition of impulses and diminished capacity for self-monitoring. These deficits in reasoning and judgment may prevent the patient from comprehending the significance of their HIV status and the consequences of sexual behavior or needle sharing. There are indications that the Tarasoff duty-to-protect may apply to this situation.

METHOD

Available data about the prevalence of HIV risk behavior and HIV infection among psychiatric patients are reviewed. The applicability to these situations is described.

RESULTS

When an HIV patient engages in high risk sexual behavior with identifiable partners and refuses to notify them of their HIV status, physicians and mental health professionals may have a legal and ethical duty to warn.

CONCLUSION

A decision model for this clinical dilemma is presented. Clinical strategies for these patients may include ongoing supervision and monitoring as well as possible quarantine.

Psychiatric aspects of HIV-1 infection and AIDS

The literature on the psychiatric aspects of HIV-1 infection is reviewed. The whole range of psychiatric disorders described in HIV-1 infected subjects, from HIV-1 dementia to adjustment disorders, is covered, along with the AIDS-related psychopathology which may develop in subjects without HIV-1 infection.

AIDS: clinical and ethical issues on a psychiatric unit

Using a case illustration, this paper describes how AIDS has affected psychiatric practice on an inpatient unit. The clinical, ethical and administrative issues are discussed from a multi-disciplinary perspective. The issues are discussed as 1. clinical issues (diagnostic and management), 2. effects on ward milieu, 3. staff issues, 4. family counselling and discharge planning and 5. administrative issues. It is important for inpatient staff to discuss these issues and develop clinical guidelines and administrative procedures that will help staff provide the highest level of care possible. Because every patient is potentially an HIV carrier, many of the solutions developed around AIDS related concerns should apply to all patients on a psychiatric ward.