Douaihy Antoine B, Jou Roger J, Gorske Tad, Salloum Ihsan M
University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania, USA.
AIDS Read. 2003 Jul;13(7):331-2, 339-41.
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.
物质使用障碍和精神疾病通常同时出现，即所谓的双重诊断。随着艾滋病毒感染在双重诊断患者中的传播，三重诊断已成为初级保健医生、成瘾医学专家和精神科医生面临的具有临床挑战性的情况。现有数据表明，在精神科、药物滥用和艾滋病毒治疗环境中，三重诊断患者的患病率很高。本综述强调了物质滥用-精神疾病的特征及其与抗逆转录病毒治疗使用、依从性和艾滋病毒治疗结果变化的关联。应对物质滥用和心理健康问题的综合和跨学科方法应是全面艾滋病毒护理的主要要素。评估心理药物和心理治疗干预的安全性和有效性以及理解三重诊断各组成部分之间的复杂相互作用是未来研究的领域。应开发并实施基于“一站式服务”的服务提供和干预模式，以优化临床结果。
