Prevention Strategies

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Suicide prevention starts with taking a suicide history of every patient with HIV. Clinicians need to feel comfortable discussing suicide in depth.

Countertransference reactions play a major role in being able to have a productive dialogue with the suicidal patient and establishing a therapeutic alliance. Feelings are contagious, and the overwhelming hopelessness of a suicidal individual may interfere with the clinician's ability to infuse hope and help the patient find alternatives to premature death. Far from harming the patient, being able to put feelings into words to express suicidal impulses is highly relieving and can prevent acting out aggressively. When a suicidal person verbalizes his or her suicidal ideas and plans, a different perspective can be attained as unendurable affects are expressed. Listening with empathy at a moment of crisis can begin to dissipate hopelessness and mobilize the will to live.

An adequate suicide history includes an assessment of present suicidal ideas and plans by asking direct and open-ended questions. Since past suicide attempts are, along with hopelessness, the strongest predictors of future completed suicide, the clinician must always ask about previous attempts and elicit a family history of suicide. Timely treatment of the psychiatric disorders associated with heightened suicide risk could prevent suicide in individuals at risk. Antidepressants should be prescribed to depressed and anxious suicidal patients, but it is important to remember that anhe-donia and psychomotor retardation lift first when these are prescribed, and hopelessness, dysphoria, and suicidal behavior take longer to improve (Mann, 2005). Psychotherapy can reduce a sense of alienation, provide symptomatic relief, increase networking, and promote conflict resolution. Psychotherapy modalities that can help suicidal patients include interpersonal, cognitive-behavioral, psychodynamic, and supportive, in both individual and group therapy settings.

Physical symptoms compound psychological distress and can precipitate death by suicide. Providing symptomatic relief and palliation of nociceptive and neuropathic pain, pruritus, diarrhea, nausea, emesis, and anorexia can avert a suicidal crisis in persons with HIV infection.

There is no treatment for suicide, only prevention. Thus there may be times when a person with HIV or AIDS is overwhelmed with suicidal feelings, and the person may or may not have a prior relationship with a psychiatrist or other mental health clinician. If there is a suicide attempt or an expression of suicidal ideation, primary physicians, psychiatrists, and other mental health professionals in an emergency setting, or psychosomatic medicine psychiatrists in general care may need to assess for suicidality. In such situations, an emergency psychiatric hospitalization may be indicated if the person is found to be actively suicidal and in the midst of a suicidal crisis. Close observation by staff is essential to ensure that the suicidal individual is safe during the process of the transfer. If the medical condition does not permit transfer, then one-on-one observation should be maintained until the suicidal crisis resolves or the transfer can be accomplished.

Since suicidal persons are ambivalent by definition and will oscillate from wanting to live and opting to die, it is important to identify family members or friends who can be called on to accompany and protect patients during a time of crisis. Family members or friends can also be of assistance in minimizing access to lethal means.

In order for the suicidal person with HIV infection to resolve a suicide crisis, it is important to establish trusting relationships, reconnect with family members and significant others, restore hope, find meaning in life, and develop goals to attain a sense of fulfillment and connectedness. With support, companionship, networking, conflict resolution, palliative care, adequate medical treatment, and alleviation of psychological distress, persons with HIV infection may realize that suicide is not the only option.


Abram HS, Moore GL, and Westervelt FB (1971). Suicidal behavior in chronic dialysis patients. Am J Psychiatry 127:119-124. Abraham K (1911). Notes on the psychoanalytical investigation and treatment of manic-depressive insanity and allied conditions. In Selected Papers on Psychoanalysis (pp. 137-156). Translated by D Byran D and A Strachey. New York: Basic Books, 1960. Abraham K (1924). A short study of the development of the libido, viewed in the light of mental disorders. In Selected Papers on Psychoanalysis (pp. 418-501). Translated by D Byran and A Strachey. New York: Basic Books, 1960. Alfonso CA, and Cohen MA (1994). HIV dementia and suicide. Gen Hosp Psychiatry 16:45-46. Alfonso CA, and Cohen MA (1997). The role of group psychotherapy in the care of persons with AIDS. J Am Acad Psychoanal 25:623-638. Alfonso CA, Cohen MA, Aladjem AD, Morrison F, Powell DR, Winters RA, and Orlowski BK (1994). HIV seropositivity as a major risk factor for suicide in the general hospital. Psychosomatics 35:368-373. Barraclough B, Bunch J, Nelson B, and Sainsbury P (1974). A hundred cases of suicide: clinical aspects. Br J Psychiatry 25:355-372.

Beck AT, Steer RA, Kovacs M, and Garrison B (1985). Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 142:559-563.

Blumenthal SJ (1988). Suicide: a guide to risk factors, assessment, and treatment of suicidal patients. Med

Clin North Am 72:937-971.

Breitbart W (1987). Suicide in cancer patients. Oncology 4:49-54.

Brown GR, and Rundell JR (1989). Suicidal tendencies in women with human immunodeficiency virus infection. Am J Psychiatry 146:556-557.

Carvajal MJ, Vicioso C, Santamaria JM, and Bosco A (1995). AIDS and suicide issues in Spain. AIDS Care 7:135-138.

Castellani G, Beghini D, Barisoni D, and Marigo M (1995). Suicide attempted by burning: a 10-year study of self-immolation deaths. Burns 21(8):607-609.

Chandra PS, Ravi V, Desai A, and Subbakrishna DK (1998). Anxiety and depression among HIV-infected heterosexuals—a report from India. J Psychosom Res 45:401-409.

Cohen MA (1998). Psychiatric care in an AIDS nursing home. Psychosomatics 39:154-161.

Cohen MA (1999). Psychodynamic psychotherapy in an AIDS nursing home. J Am Acad Psychoanal 27: 121-133.

Cohen MA, and Alfonso CA (2004). AIDS psychiatry, palliative care and pain management. In GP Wormser (ed.), AIDS and Other Manifestations of HIV Infection, fourth edition (p. 566). San Diego: Elsevier Academic Press.

Cohen MA, and Merlino JP (1983). The suicidal patient on the surgical ward: multidisciplinary case conference. Gen Hosp Psychiatry 5:65-71.

Cohen MA, Aladjem AD, Brenin D, and Ghazi M (1990). Firesetting by patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 112:386-387.

Cohen MA, Alfonso CA, Hoffman R, Milau V, and Carrera G (2001). The impact of PTSD on treatment adherence in persons with HIV infection. Gen Hosp Psychiatry 23(5):294-296.

Cooperman NA, and Simoni JM (2005). Suicidal ideation and attempted suicide among women living with HIV/AIDS. J Behav Med 28(2):149-156.

Cote TR, Biggar RJ, and Dannenberg AL (1992). Risk of suicide among persons with AIDS. JAMA 268: 2066-2068.

Drake RE, and Ehrlich J (1985). Suicide attempts associated with akathisia. Am J Psychiatry 142(4): 499-501.

Farberow L, McKelligott JW, Cohen S, and Darbonne A (1966). Suicide among patients with cardiorespiratory illnesses. JAMA 195:422-428.

Frances A (1986). Personality and suicide. Ann N Y Acad Sci 487:281-293.

Freud S (1917). Mourning and Melancholia. In Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 14 (pp. 237-260). Translated and edited by J Strachey. London: Hogarth Press, 1957.

Frierson RL, and Lippmann SB (1988). Suicide and AIDS. Psychosomatics 29:226-231.

Gala C, Pergami A, Catalan J, Riccio M, Durbano F, Musicco M, Baldeweg T, and Invernizzi G (1982). Risk of deliberate self-harm and factors associated with suicidal behaviors among asymptomatic individuals with human immunodeficiency virus infection. Acta Psychiatr Scand 86:70-75.

Gil F, Passik S, Rosenfeld B, and Breitbart W (1998). Psychological adjustment and suicidal ideation in patients with AIDS. AIDS Patient Care STDs 12(12):927-930.

Glass RM (1988). AIDS and suicide. JAMA 259:13691370.

Glickman LS (1980). The suicidal patient. In LS Glickman (ed.), Psychiatric Consultation in the General Hospital (pp. 181-202). New York: Marcel Dekker.

Goggin K, Sewell M, Ferrando S, Evans S, Fishman B, and Rabkin J (2000). Plans to hasten death among gay men with HIV/AIDS: relationship to psychological adjustment. AIDS Care 12(2):125-136.

Gotoh T, Ajisawa A, Negishi M, and Yamaguchi T (1994). A study of suicide and attempted suicide in HIV carriers and patients with AIDS. Xth International Conference on AIDS, Yokohama, Japan. 10:400 [abstract].

Guze SB, and Robins E (1970). Suicide and primary affective disorder. Br J Psychiatry 117:437-438.

Haas DW, Morgan ME, and Harris VL (1997). Increased viral load and suicidal ideation in an HIV-infected patient. Ann Intern Med 126(1):86-87.

Haller DL, and Miles DR (2003). Suicidal ideation among psychiatric patients with HIV: psychiatric morbidity and quality of life. AIDS Behav 7(2): 101-108.

Harris EC, and Barraclough BM (1994). Suicide as an outcome for medical disorders. Medicine 73:281296.

Heckman TG, Miller J, Kochman A, Kalichman SC, Carlson B, and Silverthorn M (2002). Thoughts of suicide among HIV-infected rural persons enrolled in a telephone-delivered mental health intervention. Ann Behav Med 24(2):141-148.

Huntington G (1872). On chorea. Med Surg Reporter 26:317-321.

James IP (1967). Suicide and mortality among heroin addicts in Britain. Br J Addict 62:391-398.

Kahana E, Lebowitz W, and Alter M (1971). Cerebral multiple sclerosis. Neurology (Minn) 21:1179-1185.

Kalichman SC, Heckman T, Kochman A, Sikkema K, and Bergholte J (2000). Depression and thoughts of suicide among middle-aged and older persons living with HIV-AIDS. Psychiatr Serv 51:903-907.

Kaplan A, and Klein R (1989). Women and suicide. In D Jacobs and H Madison (eds.), Suicide: Understanding and Responding (pp. 257-282). Madison, CT: International Universities Press.

Kelly B, Raphael B, Judd F, Perdices M, Kernutt G, Burnett P, Dunne M, and Burrows G (1998). Suicidal ideation, suicide attempts, and HIV infection.

Psychosomatics 39:405-415.

Kizer KW, Green M, Perkins CI, Doebbert G, and Hughes MJ (1988). AIDS and suicide in California. JAMA 260:1881.

Kumar AM, Berger JR, Eisdorfer C, Fernandez JB, Goodkin K, and Kumar M (2001). Cerebrospinal fluid 5-hydroxytryptamine and 5-hydroxyindoleace-tic acid in HIV-1 infection. Neuropsychobiology 44(1):13-18.

Kurella M, Kimmel PL, Young BS, and Chertow GM (2005). Suicide in the United States end-stage renal disease program. J Am Soc Nephrol 16(3):774-781.

Larsson M, Hagberg L, Norkrans G, and Forsman A (1989). Indole amine deficiency in blood and cere-brospinal fluid from patients with human immunodeficiency virus infection. J Neurosci Res 23(4): 441-446.

Leibenluft E, and Goldberg RL (1998). The suicidal terminally ill patient with depression. Psychoso-

matics 29:379-386.

Lewden C, Salmon D, Morlat P, Bevilacqua S, Jougla E, Bonnet F, Heripret L, Costagliola D, May T, and Chene G (2005). Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role ofhepatitis and cancers, persistent role ofAIDS. Int J Epidemiol 34(1):130-131.

Litman R (1989). Suicides: what do they have in mind? In D Jacobs and H Brown (eds.), Suicide: Understanding and Responding (pp. 143-154). Madison, CT: International Universities Press.

Louhivuori KA, and Hakama M (1979). Risk of suicide among cancer patients. Am J Epidemiol 109:59-65.

Malenfant EC (2004). Suicide in Canada's immigrant population. Health Reports 5:9-17.

Malone KM, Oquendo MA, Haas GL, Ellis SP, Li S, and Mann JJ (2000). Protective factors against suicidal acts in major depression: reasons for living.

Am J Psychiatry 157(7):1331-1332.

Mann JJ (2005). The medical management of depression. N Engl J Med 353:1819-1834.

Mann JJ, Apter A, BertoloteJ, Beautrais A, Currier D, Haas A, Hegerl U, Lonnqvist J, Malone K, Marusic A, Mehlum L, Patton G, Phillips M, Rutz W, Rihmer Z, Schmidtke A, Shaffer D, Silverman M, Takahashi Y, Varnik A, Wasserman D, Yip P, and Hendin H (2005). Suicide prevention strategies—a systematic review. JAMA 294(16):2064-2074.

Marzuk PM, Tierney H, Tardiff K, Gross EM, Morgan EB, Hsu MA, and Mann JJ (1988). Increased risk of suicide in persons with AIDS. JAMA 259:13331337.

Marzuk PM, Tardiff K, Leon AC, Stajic M, Morgan EB, and Mann JJ (1992). Prevalence of cocaine use among residents of New York City who committed suicide during a one-year period. Am J Psychiatry 149:371-375.

Marzuk PM, Tardiff K, Leon AC, Hirsch CS, Hartwell N, Portera L, and Iqbal MI (1997). HIV seroprev-alence among suicide victims in New York City,

1991-1993. Am J Psychiatry 154:1720-1725.

McHugh PR (1994). Suicide and medical afflictions. Medicine 73:297-298.

McIntosh J (2003). U.S.A. Suicide: Suicide Data (p. 2001). Washington, DC: American Association of Suicidology.

Miles CP (1977). Conditions predisposing to suicide: a review. J Nev Ment Dis 164:231-246.

O'Cleirigh C, Ironson G, Antoni M, Fletcher MA, McGuffey L, Balbin E, Schneiderman N, and Solomon G (2003). Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS. J Psychosom Res 54(3):225-235.

Oquendo M, Brent DA, Birmaher B, Greenhill L, Kolko D, Stanley B, Zelazny J, Burke AK, Firinciogullari S, Ellis SP, and Mann JJ (2005a). Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior. Am J Psychiatry 162(3):560-566.

Oquendo MA, Dragatsi D, Harkavy-Friedman J, Dervic K, Currier D, Burke AK, Grunebaum MF, and Mann JJ (2005b). Protective factors against suicidal behavior in Latinos. J Nerv Ment Dis 193(7):438-443.

Pavlovic E, and Marusic A (2001). Suicide in Croatia and in Croatian immigrant groups in Australia and Slovenia. Croat Med J 42(6):669-672.

Perry S, Jacobsberg L, and Fishman B (1990). Suicidal ideation and HIV testing. JAMA 263:679-682.

Pierce C (1987). Underscore urgency of HIV counseling: several suicides follow positive tests. Clin Psychiatry News October 1.

Pirkola SP, Isometsa ET, Heikkinen ME, and Lonnqvist JK (2000). Suicides of alcohol misusers and non-misusers in a nationwide population. Alcohol

Alcohol 35(1):70-75.

Plott RT, Benton SD, and Winslade WJ (1989) Suicide of AIDS patients in Texas: a preliminary report. Tex Med 85:40-43.

Pokorny AD (1966). A follow-up study of 618 suicidal patients. Am J Psychiatry 122:1109-1116.

Pompili M, Ruberto A, Girardi P, and Tatarelli R (2004). Suicide in schizophrenia. What are we going to do about it? Ann Ist Super Sanita 40(4):463-467.

Quan H, Arboleda-Florez J, and Flick G (2002). Association between physical illness and suicide among the elderly. Soc Psychiatry Psychiatr Epidemiol 37:190-197.

Rabkin JG, Williams JB, Neugebauer R, Remien RH, and Goetz R (1990). Maintenance of hope in

HIV-spectrum homosexual men. Am J Psychiatry 147(10):1322-1326.

Rabkin JG, Remien R, Katoff L, and Williams JB (1993). Resilience in adversity among long-term survivors of AIDS. Hosp Community Psychiatry 44(2):162-167.

Rajs J, and Fugelstad A (1992). Suicide related to human immunodeficiency virus infection in Stockholm. Acta Psychiatr Scand 85:234-239.

Ricart F, Cohen MA, Alfonso CA, Hoffman RG, Quinones N, Cohen A, and Indyk D (2002). Understanding the psychodynamics of non-adherence in persons with PTSD and HIV infection. Gen Hosp Psychiatry 24(3):176-180.

Rosengard C, and Folkman S (1997). Suicidal ideation, bereavement, HIV serostatus and psychosocial variables in partners of men with AIDS. AIDS Care 9(4):373-384.

Roy A (1986). Suicide in schizophrenia. In A Roy (ed.), Suicide (pp. 97-112). Baltimore: Williams & Wilkins.

Roy A (2003). Characteristics of HIV patients who attempt suicide. Acta Psychiatr Scand 107(1):41-44.

Rundell JR, Wise ME, and Ursano RJ (1986). Three cases of AIDS-related psychiatric disorders. Am J Psychiatry 143:777-778.

Rundell JR, Kyle KM, Brown GR, and Thomason JL (1992). Risk factors for suicide attempts in a human immunodeficiency virus screening program. Psy-chosomatics 33:24-27.

Ruzicka LT, Choi CY, and Sadkowsky K (2005). Medical disorders of suicides in Australia: analysis using a multiple-cause-of-death approach. Soc Sci

Sabbath J (1969). The suicidal adolescent: the expendable child. J Am Acad Child Psychiatry 8:272-289.

Schoenfeld M, Myers RH, Cupples LA, Berkman B, Sax DS, and Clark E (1984). Increased rate of suicide among patients with Huntington's disease. J Neurol Neurosurg Psychiatry 47:1283-1287.

Scholten MR and Selten JP (2005). Suicidal ideations and suicide attempts after starting on aripiprazole, a new antipsychotic drug. Ned Tijdschr Geneeskd 149(41):2296-2298.

Semela D, Glatz M, Hunziker D, Scmid U, and Vernazza PL (2000). Cause of death and autopsy findings in patients of the Swiss HIV Cohort Study (SHCS). J Suisse Med 130:1726-1733.

Shear MK, Frances A, and Weiden P (1983). Suicide associated with akathisia and depot fluphenazine treatment. J Clin Psychopharmacol 3(4):235-236.

Sher L, Oquendo MA, Burke AK, Grunebaum MF, Zalsman G, Huang YY, and Mann JJ (2005). Higher cerebrospinal fluid homovanillic acid levels in depressed patients with comorbid posttraumatic stress disorder. Eur Neuropsychopharmacol 15(2): 203-209.

Sherr L (1995) Suicide and AIDS: lessons from a case note audit in London AIDS Care 7 (Suppl 2):109-116.

Sindiga I, and Lukhando M (1993). Kenyan university students' views on AIDS. East Afr Med J 70:713716.

Vaillant GE (1966). A twelve-year follow-up ofNew York narcotic addicts. Am J Psychiatry 122:727-737.

Wood KA, Nairn R, Kraft H, Siegel (1997). Suicidality among HIV-positive psychiatric in-patients. AIDS Care 9(4):385-389.

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Part V

Neuropathologic Manifestations of HIV Infection

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