Analysis of psychiatric consultations in patients with HIV infection and related syndromes.

All the requests transmitted to the Service of Consultation-Liaison Psychiatry (C-LPS) of the University of Ferrara for patients admitted to the S.Anna Hospital, Ferrara, Italy, during a period of one year (january-december 1993) were gathered. S.Anna Hospital is a large city hospital with 1235 beds and over 30,000 admissions per year. Psychiatric diagnoses, following DSM-III-R criteria, as registered by the consultant, the rate of consultation for each patient (total number of consultations/number of patients) and the time spent per patient were also taken into account for analysis. A comparison between requests and subsequent psychiatric diagnosis for HIV-infected patients with respect to non-HIV patients was made. Analysis was performed on 571 requests. Seventy-five requests (13.13%) regarded HIV infected patients (41 males and 34 females) admitted to the Division of Infectious Disease and the remaining 496 physically ill and HIV-negative patients (296 females and 200 males) admitted to the other medical or surgical divisions of S.Anna Hospital. 28 HIV+ subjects were in CDC group III and 47 in CDC group IV (AIDS). A significant difference was found between HIV and non-HIV patients as regard age (32.4 yrs. ± 7.8 vs 49.7 ± 18.8, p < ). The most frequent reason for referral both in HIV and non-HIV groups was the presence of psychiatric symptoms (anxiety, depression, behavioural disroders, confusional state, psychiotic symptoms). Requests for HIV-positive patients differed from those of uninfected patients in reporting a lower suspected presence of functional symptoms (16% vs. 35.9%, p < 0.001) and higher presences of maladaptive psychological reactions (56% vs. 25.35% p < 0.01) and patient’s requests (17.33% vs. 2.83%, p < 0.0001). No difference was found in the categories Urgency (within one hour/within 24 hours/routine) and Type of treatment (psychotropic intervention/psychological counseling/family counseling/meeting with the staff/transfer to psychiatric ward), as requested by the referring doctor. With regard to DSM-III-R psychiatric diagnoses, as evaluated by the consultant, HIV+ patients were found to have a significantly higher rate of psychoactive substance abuse disorder, organic mental disorders, particularly dementia (13.79% vs. 1.99%, p < 0.0001) and a depressive disorder NOS (10.3% vs. 3.56% p < 0.05). The number of consultations per patient was higher in AIDS patients than in other conditions (4.8 vs. 2.3), as well as the mean total time dedicated to each patient (7.3 hours vs. 3.4 hours)