Dear Corrections Colleagues,
A substantial proportion of persons living with HIV infection in the United States are incarcerated and among these, many -- if not the great majority -- suffer from psychiatric illnesses. Mental illness places people at risk for acquiring HIV and for those already HIV-infected, complicates treatment and prevention efforts. As most of us have observed, abuse of alcohol, cocaine, heroin and other illicit substances is often a form of self-treatment among the depressed and traumatized, increasing not only their odds for infection with HIV and viral hepatitis, but also for incarceration. In this issue of the IDCR, Drs. Andrew Angelino and Glenn Treisman, psychiatrists leading Psychiatric Services for the Johns Hopkins HIV/AIDS Care Program, provide a guide to the diagnosis and treatment of the most prevalent mental health disorder of HIV-infected individuals -- major depression. Drs. Angelino and Treisman have authored a useful book, The Psychiatry of AIDS, available in paperback and a "must-read" for HIV health care providers -- particularly those in corrections. Their article is complemented by a series of illuminating cases from Dr. Jeffery Watts, Psychiatric Medical Director at the CORE Center, a large clinic specializing in mental health care for HIV-infected patients which is associated with Cook County Hospital in Chicago.
I hope this issue, my first as editor, will raise awareness of the need to screen all HIV-infected inmates for mental illnesses and provide a starting point for continued clinician education on the detection and management of mental health disorders in correctional settings. Reading this issue has made it clear to me that the benefits patients can accrue when their psychiatric illnesses are addressed is multiple and includes improved quality of life, enhanced medical adherence, reduced substance abuse and adoption of HIV transmission prevention measures. After reading this issue, individuals should be able to differentiate between major depression and reactive states which can produce depressive symptoms, appreciate the differential diagnosis of depression in the HIV-infected inmate and understand the approaches to the pharmacologic and psychotherapeutic treatment of depression in such patients.
In closing, I wish to thank you for the work you do, often in a difficult environment with patients who do not always appreciate the value of the help you are offering. The IDCR staff, including the editorial board of experienced and insightful providers in correctional health care, aim to provide you with the information you need to continue to deliver high quality care. During the next year we will address topics most relevant to your work and will enhance our website to provide clinical resources we hope you will find useful. We can best accomplish these aims with feedback from you, our readers. Feel free to email me regarding the content of the IDCR at firstname.lastname@example.org.