Infectious disease psych?

[grandslam521]

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Does anyone know of psychiatrists who have an expertise or self-declared specialization in infectious disease, whether the disease be a manifestation of a psychiatric illness (delusion, somatization, etc) or an actual infectious disease that has psychiatric manifestations?

 

[masterofmonkeys]

Does anyone know of psychiatrists who have an expertise or self-declared specialization in infectious disease, whether the disease be a manifestation of a psychiatric illness (delusion, somatization, etc) or an actual infectious disease that has psychiatric manifestations?

the closest thing I can think of is AIDS psych. Which is an emerging field. AIDS dementia/psychosis. And some of the meds have been implicated in psych issues as well.

 

[BobA]

I know of a psychiatrist who only sees hepatitis patients. He works in a VA. I don't think he has any special training beyond psych - just an interest

 

[howelljolly]

syphilis and lyme disease come to mind

I dont know anything about anything, but I think that a fellowship in psychosomatic medicine might be up your alley.

 

[Doc Samson]

HIV psychiatry is the most clearly delineated "sub-sub-specialty" group with folks like Frank Fernandez at USF and Marshall Forstein at Cambridge leading the pack. I'd agree that a CL fellowship is the way to go for this.

 

[whopper]

I'll name a list of situations I can think off the top of my head, I'm sure I'm missing a lot of important ones.

HIV-already mentioned
Herpes encephalitis or any encephalitis for that matter, can cause psychiatric symptoms
Hepatitis C-correlated with a lot of psyche disorders but the cure-interferon is associated with a lot of psyche problems. Emory as far as I know is the head institution studying the psychiatric effects of interferon
PANDAS--OCD sx being caused by Streptococcus
Lyme Disease-can cause chronic fatigue syndrome, and a whole host of psyche sx
Syphillis if it gets to the point where it spreads to the brain can cause of lot of psyche problems. A reason why several places demand psychiatrists do an RPR before admission of a patient
Delerium being caused by any infections, but usually UTIs in the elderly.
Skin infections with E.coli are sometimes a sign of factitious disorder, where the patient cut themself & infected themself with their own feces.


Several psyche meds can increase the risk of infection or make treating infection very difficult
E.g. Clozapine, Olanzapine & Mirtazapine all can lower white blood cell count. We all of course know of the warnings in Clozaril, and many of us know Mirtazapine can cause agranulocytosis, but its rare to the point where its often not tested. However, I've seen data from psychiatrists at Jefferson showing that Mirtazapine can lower WBC on a subclinical level. This needs to make a psychiatrist think twice about giving it to anyone in need of a strong immune system such as a cancer or HIV patient.

And if a patient is on a psyche med that lowers WBC, you need to consider several situations where the patient may have an infection but because of a dampened WBC count, they might not show the classic signs of an infection. E.g. an IM doctor at my psychiatric hospital who only sees psyche patients told me that she had a few patients who had an ear infection & were on Clozapine & never showed any inflammatory related sx with the ear infection because their neutrophil levels were lowered. She told me that if you got a patient on Clozapine, treatment for something like an ear infection could be delayed, causing irreparable damage before the person feels the symptoms to make it known to their psychiatrist that an ear infection may be an issue.

 

[whopper]

Because of this thread, and since I never heard about it again I decided to do a looksie on the old Depakote may help HIV theory.

This is what I found.

http://www.aidsmeds.com/articles/1667_11202.shtml

In short, there was theory with some weak evidence to believe that Valproic Acid helped to get rid of the HIV virus that was hiding intracellularly. I seemed to be the only psychiatrist I knew of that remembered that news because every time I brought it up to another psychiatrist, none of them knew what I was talking about.

But alas, the article shows further studies were done on Valproic acid possibly benefiting HIV patients & found nothing substantial (though the work only involved 9 patients, IMHO that's not enough to dispell it).

Not psychiatry related but apparently someone with HIV may have been recently cured of it....
http://www.independent.co.uk/life-s...caution-over-transplant-hiv-cure-1017942.html

 

[howelljolly]

Has anyone else noticed that the kidneys of patients that are on antipsychotic meds (but not lithium) do a really bad job of handling ABX for infection?

 

[whopper]

Haven't noticed that. Have you?

 

[howelljolly]

In my own anecdotal meager experience, yes. Nephrotoxic ABX that most patients can handle fairly well had sent a couple of patients that I saw, who were on psych meds into ARF requiring HD.

 

[whopper]

Well, several patients on antipsychotics often times have worse metabolic profiles, due to the meds &/or their disorders. There is a lot of data pointing to Schizophrenics having worse metabolic profiles having nothing to do with their medications, & are at higher risk for dyslipidemia, obesity & diabetes --> which can worsen their renal function.

The meds in question may also have interacted. I've noticed several doctors not carrying a PDA & double checking the interactions between meds.

With the millions of possible interactions between meds, its impossible for a doctor to be aware of all of them other than the more common & dangerous ones. Pretty much anyone on a lot of meds or meds I'm not familiar with, I do an Epocrates interaction search. I've noticed I'm one of the few doctors that I know of that does this. That's not a compliment of myself, but merely acknowledgement that I'm aware of my limitations.

I haven't yet met a doctor that could be on top of every single interaction to an acceptable level on their own, yet few do a PDA or computer search on one of the available programs that check for them.