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A substantial number of HIV-infected individuals also suffer from serious mental illness

The first State-wide report on community-dwelling patients with serious mental illness and HIV/AIDS reveals that the co-existence of these two conditions may pose a significant clinical and public health problem. Among 8,294 Medicaid-insured patients with HIV disease in New Jersey, 6 percent suffered from schizophrenia and 7 percent from a major affective disorder, such as major depressive disorder or bipolar disorder. In comparison, schizophrenia affects only 1 percent of the general population. Preparation of the report was supported in part by the Agency for Health Care Policy and Research (HS06339).

Ironically, HIV has spread to psychiatrically disabled patients just as treatments have become both increasingly effective and more complex. Clinicians must determine when and how to provide antiviral combination therapies to these patients, who may find it more difficult to adhere to the complex drug treatments, explains the study's principal investigator Stephen Crystal, Ph.D. Dr. Crystal and his Rutgers University colleagues merged the New Jersey HIV/AIDS Registry with Medicaid eligibility files to identify and characterize seriously mentally ill patients with HIV infection.

The researchers found that those with schizophrenia were more apt than other patients to be injection drug users and to have Medicaid claims indicative of substance abuse. Also, they were more likely to be diagnosed with HIV rather than AIDS, suggesting more recent infection than other patients. Seventy-seven percent of this group had indications of a substance abuse problem. Individuals with a major affective disorder were more apt to be white, female, and residents of rural areas. Although HIV disease may sometimes trigger psychiatric dysfunction, it is likely that many seriously mentally ill individuals with HIV infection are among the group with long-term chronic mental illness, conclude the researchers. They call for further research to examine the risks faced by seriously mentally ill individuals in the community and to shed light on their experiences when treated with combination antiviral regimens.

For more details, see "Schizophrenia and major affective disorder among Medicaid recipients with HIV/AIDS in New Jersey," by James Walkup, Ph.D., Dr. Crystal, and Usha Sambamoorthi, Ph.D., in the July 1999 American Journal of Public Health 89(7), pp. 1101-1103.

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