Drug abuse, psychiatric disorders, and AIDS. Dual and triple diagnosis (1990)

FRANÇAIS :
A partir de cas de patients présentant un double diagnostic (toxicomanie, troubles psychiatriques) ou un triple diagnostic (toxicomanie, troubles psychiatriques et sida), les problèmes d'évaluation et de traitement spécifiques à ces malades sont abordés. Les médecins doivent être maintenant formés pour la prise en charge de patients infectés par le VIH, nécessitant par ailleurs sevrage et soins psychiatriques. De nouveaux services de soins doivent donc être mis en place pour traiter de tels malades.
ENGLISH:
Substance abuse and psychiatric disorders commonly occur together. This form of dual diagnosis is notable because it complicates assessment and makes treatment more difficult for both psychiatric and drug abuse problems. Drugs can cause psychiatric disorders and can also be used as an attempt to "cure" them by self-medication. The spread of the human immunodeficiency virus (HIV) among drug users has added a third potential clinical problem, that of the acquired immunodeficiency syndrome, to the difficulties already presented by drug abuse and psychiatric disorders. Patients with this triple diagnosis pose challenges to primary care physicians as well as addiction medicine specialists or psychiatrists. Assessment should include a drug abuse history, preferably corroborated by others, evaluation of the mental state, and examination focusing on signs of drug abuse and HIV infection. Treatment should include the management of HIV disease, abstinence from drug abuse, and access to psychiatric care. New systems of health care service, including interdisciplinary case management, may be needed to manage patients with a triple diagnosis.