Aids and drug abuse: some aspects of psychiatric consultation (1989)

FRANÇAIS :
A Buenos Aires, environ 30 % des toxicomanes sont contaminés par le VIH et présentent des troubles du comportement. Ils consultent divers spécialistes, ce qui accroît encore leur anxiété. Le médecin refusant inconsciemment d'être impliqué dans cette anxiété les oriente vers un psychiatre. Le psychiatre doit appréhender la situation comme une crise dans la relation malade-médecin. Ces patients souffrant de troubles sérieux doivent trouver un soutien et une prise en charge efficaces auprès de médecins sensibilisés à ces problèmes.
ENGLISH:
Current research in Buenos Aires shows that approximately 35 per cent of intravenous users are HIV positive. These patients have behaviour disorders. Usually they are sent from one specialist to another, which increases their anxiety that originated in their suspicion of a serious prognosis. They are listened to when they discuss their disease but not enough when they try to talk about themselves as people with doubts about their future. Unconsciously physicians are trying to avoid involvement in the anxiety of the patient by means of a referral to a psychiatric consultation. The psychiatrist must handle this situation as a crisis in the doctor-patient relationship (both need help) to preventing further acts, additional anxiety and psychotic reactions. These patients need strong support not only because of the seriousness of the disease but also because of the situation of abstinence. Global treatment of a patient should be unified and managed by a physician with psychological training or assessed by one liaison psychiatrist, trying to avoid any split in the health team.
PIP:
The rapidly rising number of HIV-infected intravenous drug users in Buenos Aires has produced unprecedented difficulties in the physician-patient relationship and a need for greater involvement on the part of mental health specialists. At present, 35% of these drug users are HIV-positive. When hospitalized for various medical complications of the virus, drug users often manifest acting out behaviors, denial of their addiction, and other psychopathic personality traits. They are likely to be noncompliant with treatment regimens and demanding of special treatment from hospital staff. In many cases, physicians seek to protect themselves from involvement with these difficult, highly anxious patients by making a referral to a psychiatrist. Although such a referral is usually appropriate, physicians should seek to work through the crisis in the physician-patient relationship and address psychosocial as well as medical issues. Failure on the part of the physician to navigate the initial disorganizing crisis and symbiotic stages can produce serious depression in the patient, a sense of abandonment, and a worsening of the medical condition.