HIV Psychiatry Treatment Consensus Survey
Results
Brief Guide to Interpretation of Results Tables
RAND Corporation 9-point Rating Scale
- 1 – extremely inappropriate: a treatment you would never use
- 2-3 – usually inappropriate: a treatment you would rarely use
- 4-6 – equivocal: a second line you would sometimes use (e.g., patient/family preference or if 1st line treatment is ineffective, unavailable or unsuitable)
- 7-8 – usually appropriate: a 1st line treatment you would often use
- 9 – extremely appropriate: this is your treatment of choice
Three treatment tiers based on average responses
- First-line treatment (i.e., a usual and appropriate first choice)
— A range between 6.5 to 9
- Second-line treatment (i.e., a reasonable choice if patients cannot tolerate 1st choice or specific patient factors are present to suggest such a choice)
— A range between 3.5 and 6.49
- Third-line treatment (i.e., usually inappropriate and only used if other approaches have failed)
— A range between 1 to 3.49
Information provided in Results Tables
- Mean response, standard deviation (SD), and 95% confidence interval (95% CI)
- Answers are ranked and grouped into three treatment tiers based on average responses
- TOC (treatment of choice) – percentage of respondent who chose 9
- For each treatment tier, percentage of respondents is listed as well
SECTION I: PSYCHOPHARMACOLOGIC TREATMENTS
Choice of First-Line Antidepressants
| Newly Diagnosed HIV and HAART-Naive |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Escitalopram |
7.5 |
1.5 |
7.15-7.94 |
25% |
82% |
16% |
2% |
| 2 |
Citalopram |
7.5 |
1.4 |
7.12-7.89 |
|
75% |
11% |
4% |
| 2nd Line: |
| 3 |
Sertraline |
6.7 |
1.9 |
6.22-7.23 |
|
68% |
25% |
7% |
| 4 |
Mirtazepine |
6.2 |
2.0 |
5.68-6.75 |
|
61% |
28% |
11% |
| 5 |
Bupropion |
6.2 |
1.9 |
5.70-6.75 |
|
49% |
38% |
13% |
| 6 |
Venlafaxine |
6.2 |
1.7 |
5.72-6.61 |
|
44% |
47% |
9% |
| 7 |
Duloxetine |
5.9 |
1.9 |
5.40-6.45 |
|
40% |
49% |
11% |
| 8 |
Fluoxetine |
5.1 |
2.3 |
4.48-5.7 |
|
33% |
40% |
27% |
| 9 |
Paroxetine |
4.2 |
2.5 |
3.53-4.90 |
|
24% |
29% |
47% |
| 10 |
Methylphen |
3.6 |
2.0 |
3.10-4.18 |
|
22% |
27% |
51% |
| 11 |
Nortriptyline |
3.5 |
1.8 |
2.98-3.97 |
|
4% |
41% |
55% |
| 3rd Line: |
| 12 |
Amphetamine |
3.3 |
2.1 |
2.75-3.86 |
|
7% |
33% |
60% |
| 13 |
Desipramine |
3.1 |
1.8 |
2.65-3.64 |
|
4% |
44% |
62% |
| 14 |
Amitriptyline |
2.6 |
1.3 |
2.28-3.00 |
|
0% |
72% |
28% |
| 15 |
Fluvoxamine |
2.5 |
1.8 |
1.98-2.93 |
|
4% |
14% |
82% |
| 16 |
MAOI |
1.4 |
1.0 |
1.25-1.77 |
|
0% |
4% |
96% |
|
|
|
|
|
|
|
|
|
| HIV Patient on Ritonavir-boosted PI-based HAART |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Citalopram |
7.8 |
1.1 |
7.53-8.13 |
25% |
88% |
12% |
0% |
| 2 |
Escitalopram |
7.6 |
1.7 |
7.10-8.02 |
|
83% |
15% |
2% |
| 2nd Line: |
| 3 |
Sertraline |
6.3 |
2.1 |
5.74-6.90 |
|
59% |
30% |
11% |
| 4 |
Mirtazepine |
5.8 |
2.3 |
5.11-6.39 |
|
31% |
48% |
21% |
| 5 |
Venlafaxine |
5.5 |
1.9 |
4.98-6.04 |
|
30% |
57% |
13% |
| 6 |
Duloxetine |
5.4 |
2.2 |
4.78-6.02 |
|
34% |
48% |
18% |
| 7 |
Bupropion |
5.0 |
2.2 |
4.42-5.61 |
|
29% |
43% |
28% |
| 8 |
Fluoxetine |
4.2 |
2.5 |
3.50-4.92 |
|
23% |
32% |
45% |
| 9 |
Paroxetine |
3.7 |
2.4 |
3.01-4.35 |
|
21% |
26% |
53% |
| 10 |
Methylph |
3.7 |
2.0 |
3.17-4.32 |
|
6% |
49% |
45% |
| 11 |
Amphetamine |
3.5 |
2.1 |
2.87-4.05 |
|
4% |
44% |
52% |
| 3rd Line: |
| 12 |
Nortriptyline |
2.9 |
1.8 |
2.40-3.40 |
|
12% |
20% |
68% |
| 13 |
Desipramine |
2.8 |
1.6 |
2.31-3.22 |
|
2% |
27% |
71% |
| 14 |
Amitriptyline |
2.2 |
1.3 |
1.88-2.59 |
|
0% |
14% |
86% |
| 15 |
Fluvoxamine |
2.0 |
1.9 |
1.52-2.56 |
|
6% |
9% |
85% |
| 16 |
MAOI |
1.1 |
1.1 |
1.24-1.86 |
|
0% |
4% |
96% |
|
|
|
|
|
|
|
|
|
| HIV Patient on Efavirenz-based HAART |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Citalopram |
7.7 |
1.1 |
7.41-8.04 |
16% |
90% |
8% |
2% |
| 2 |
Escitalopram |
7.7 |
1.4 |
7.28-8.06 |
|
74% |
24% |
2% |
| 2nd Line: |
| 3 |
Sertraline |
6.2 |
2.2 |
5.58-6.81 |
|
54% |
26% |
20% |
| 4 |
Venlafaxine |
5.7 |
2.0 |
5.13-6.24 |
|
37% |
51% |
12% |
| 5 |
Bupropion |
5.5 |
2.2 |
4.92-6.16 |
|
44% |
38% |
18% |
| 6 |
Mirtazepine |
5.3 |
2.5 |
4.62-6.02 |
|
38% |
36% |
26% |
| 7 |
Duloxetine |
5.3 |
2.4 |
4.60-5.97 |
|
37% |
41% |
22% |
| 8 |
Fluoxetine |
4.5 |
2.3 |
3.88-5.17 |
|
25% |
38% |
37% |
| 9 |
Paroxetine |
3.8 |
2.3 |
3.13-4.44 |
|
18% |
25% |
57% |
| 10 |
Methylph |
3.5 |
2.0 |
2.97-4.07 |
|
10% |
37% |
53% |
| 3rd Line: |
| 11 |
Amphetamine |
3.2 |
2.1 |
2.58-3.74 |
|
10% |
29% |
61% |
| 12 |
Nortriptyline |
3.0 |
1.7 |
2.52-3.48 |
|
4% |
31% |
65% |
| 13 |
Desipramine |
2.8 |
1.6 |
2.33-3.24 |
|
2% |
27% |
71% |
| 14 |
Fluvoxamine |
2.3 |
1.4 |
1.77-2.81 |
|
6% |
12% |
82% |
| 15 |
Amitriptyline |
2.3 |
1.3 |
1.98-2.72 |
|
0% |
17% |
83% |
| 16 |
MAOI |
1.44 |
0.9 |
1.19-1.69 |
|
0% |
2% |
98% |
|
|
|
|
|
|
|
|
|
Ineffective Initial Antidepressant
|
| Change If No Benefit |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
NSRI |
7.0 |
1.7 |
6.51-7.49 |
19% |
70% |
24% |
6% |
| 2 |
Bupropion |
6.8 |
1.9 |
6.23-7.28 |
|
69% |
23% |
8% |
| 3 |
2nd SSRI |
6.7 |
2.2 |
6.07-7.29 |
|
62% |
26 |
12% |
| 2nd Line: |
| 4 |
Mirtazepine |
5.9 |
2.3 |
5.24-6.53 |
|
46% |
37% |
17% |
| 3rd Line: |
| 5 |
TCA |
3.4 |
1.8 |
2.88-3.89 |
|
4% |
38% |
58% |
| 6 |
Stimulant |
3.3 |
1.9 |
2.77-3.83 |
|
0% |
8% |
45% |
| 7 |
MAOI |
1.7 |
1.2 |
1.30-2.00 |
|
2% |
2% |
96% |
|
|
|
|
|
|
|
|
|
| Augmentation If Some Benefit |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Add 2nd AD* |
7.2 |
2.5 |
6.47-7.84 |
37% |
81% |
2% |
17% |
| 2nd Line: |
| 2 |
Add lithium |
4.1 |
2.2 |
3.53-4.75 |
|
16% |
37% |
47% |
| 3 |
Add stimulant |
4.1 |
2.2 |
3.46-4.70 |
|
17% |
41% |
42% |
| 4 |
Add SGA |
3.9 |
2.1 |
3.35-4.53 |
|
14% |
33% |
53% |
| 5 |
Add thyroid |
3.5 |
1.9 |
2.91-3.99 |
|
6% |
37% |
57% |
| 3rd Line: |
| 6 |
Add buspirone |
3.4 |
2.0 |
2.80-3.96 |
|
10% |
34% |
56% |
| * non-SSRI |
|
|
|
|
|
|
|
|
|
Duration of Antidepressant Treatment
|
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
6 – 12 mos |
7.1 |
2.5 |
6.40-7.80 |
44% |
68% |
24% |
8% |
| 2 |
12+ mos |
6.9 |
2.0 |
6.33-7.5 |
|
63% |
31% |
6% |
| 2nd Line: |
| 3 |
3 – 6 mos |
3.6 |
2.6 |
2.87-4.39 |
|
22% |
26% |
52% |
| 4 |
24+ mos |
3.6 |
2.1 |
2.93-4.18 |
|
9% |
40% |
51% |
| 3rd Line: |
| 5 |
Life-time |
2.2 |
1.8 |
1.7-2.79 |
|
4% |
12% |
84% |
| 5 |
3 mos or less |
1.9 |
1.7 |
1.41-2.41 |
|
2% |
7% |
91% |
|
|
|
|
|
|
|
|
|
Frequency of Follow-Up
|
| Every week |
2% |
|
|
|
|
|
|
| Every 2 weeks |
2% |
|
|
|
|
|
|
| Every month |
43% |
|
|
|
|
|
|
| Every 6 weeks |
11% |
|
|
|
|
|
|
| Every 2 months |
25% |
|
|
|
|
|
|
| Other |
17% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Antipsychotic Choice for Psychosis (Unrelated to Dementia or Delirium)
|
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Quetiapine |
7.2 |
1.6 |
6.79-7.68 |
18% |
72% |
26% |
2% |
| 2 |
Risperidone |
6.9 |
1.9 |
6.41-7.47 |
|
76% |
14% |
10% |
| 3 |
Aripiprazole |
6.7 |
1.6 |
6.21-7.11 |
|
64% |
28% |
8% |
| 2nd Line: |
| 4 |
Olanzapine |
6.4 |
2.1 |
5.83-7.02 |
|
57% |
31% |
12% |
| 5 |
Ziprasidone |
5.1 |
2.3 |
4.49-5.79 |
|
34% |
38% |
28% |
| 6 |
FGA |
4.7 |
2.1 |
4.08-5.23 |
|
14% |
57% |
29% |
| 7 |
Paliperidone |
3.5 |
2.4 |
2.79-4.17 |
|
15% |
29% |
56% |
| 3rd Line: |
| 8 |
Clozapine |
2.3 |
1.2 |
1.93-2.6 |
|
0% |
15% |
85% |
|
|
|
|
|
|
|
|
|
Choice of Benzodiazepines for Anxiety Disorders
|
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Clonazepam |
7.3 |
1.9 |
6.81-7.84 |
37% |
69% |
27% |
4% |
| 2 |
Lorazepam |
6.8 |
1.9 |
6.22-7.29 |
|
68% |
23% |
9% |
| 2nd Line: |
|
| 3rd Line: |
| 3 |
Oxazepam |
3.6 |
2.3 |
2.94-4.26 |
|
12% |
34% |
54% |
| 4 |
Diazepam |
3.5 |
2.1 |
3.00-4.15 |
|
14% |
27% |
59% |
| 5 |
Alprazolam |
2.9 |
2.1 |
2.35-3.53 |
|
10% |
23% |
67% |
|
|
|
|
|
|
|
|
|
Treatment of Mania
|
| Secondary Mania |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Quetiapine |
7.1 |
1.5 |
6.66-7.53 |
17% |
68% |
28% |
4% |
| 2 |
VPA |
6.8 |
2.2 |
6.21-7.41 |
|
72% |
17% |
11% |
| 3 |
Risperidone |
6.8 |
1.8 |
6.27-7.27 |
|
69% |
25% |
6% |
| 4 |
Olanzapine |
6.6 |
2.2 |
6.04-7.24 |
|
61% |
28% |
11% |
| 5 |
Aripiprazole |
6.5 |
1.8 |
5.95-6.99 |
|
54% |
38% |
8% |
| 2nd Line: |
| 6 |
Lithium |
5.8 |
2.3 |
5.12-6.40 |
|
40% |
42% |
18% |
| 7 |
Ziprasidone |
4.8 |
2.6 |
4.02-5.50 |
|
34% |
28% |
38% |
| 8 |
Lamotrigine |
4.2 |
2.2 |
3.63-4.86 |
|
19% |
39% |
42% |
| 9 |
FGA |
4.2 |
2.1 |
3.58-4.72 |
|
13% |
45% |
42% |
| 10 |
CBZ/Oxcb |
3.5 |
2.2 |
2.94-4.15 |
|
12% |
31% |
57% |
| 3rd Line: |
| 11 |
Paliperidone |
3.4 |
2.4 |
2.71-4.09 |
|
16% |
24% |
60% |
| 12 |
Gabapentin |
3.3 |
2.1 |
2.68-3.85 |
|
6% |
30% |
64% |
| 13 |
Topiramate |
3.2 |
1.6 |
2.74-3.65 |
|
2% |
39% |
59% |
| 14 |
Clozapine |
1.9 |
1.3 |
1.59-2.29 |
|
0% |
12% |
88% |
|
|
|
|
|
|
|
|
|
| Maintenance Phase Treatment |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
VPA |
7.0 |
1.7 |
6.49-7.44 |
15% |
74% |
20% |
6% |
| 2 |
Quetiapine |
6.9 |
1.7 |
6.43-7.38 |
|
71% |
27% |
2% |
| 2nd Line: |
| 3 |
Aripiprazole |
6.3 |
1.9 |
5.75-6.85 |
|
54% |
34% |
12% |
| 4 |
Risperidone |
6.2 |
2.0 |
5.58-6.74 |
|
52% |
34% |
14% |
| 5 |
Olanzapine |
6.0 |
2.1 |
5.40-6.60 |
|
52% |
30% |
18% |
| 6 |
Lithium |
6.0 |
2.3 |
5.33-6.63 |
|
50% |
30% |
20% |
| 7 |
Lamotrigine |
5.7 |
2.3 |
5.06-6.32 |
|
45% |
38% |
17% |
| 8 |
Ziprasidone |
4.6 |
2.6 |
3.89-5.35 |
|
21% |
39% |
40% |
| 9 |
CBZ/Oxcb |
3.8 |
2.2 |
3.18-4.40 |
|
12% |
38% |
50% |
| 10 |
FGA |
3.5 |
1.9 |
3.01-4.07 |
|
4% |
46% |
50% |
| 3rd Line: |
| 11 |
Paliperidone |
3.4 |
2.4 |
2.72-4.07 |
|
10% |
31% |
59% |
| 12 |
Gabapentin |
3.2 |
2.0 |
2.67-3.76 |
|
8% |
27% |
65% |
| 13 |
Topiramate |
3.1 |
1.7 |
2.63-3.56 |
|
4% |
31% |
65% |
| 14 |
Clozapine |
1.9 |
1.1 |
1.56-2.17 |
|
0% |
8% |
92% |
|
|
|
|
|
|
|
|
|
Treatment of Cognitive Disorders
|
| Delirium (Not Due to Alcohol or Benzodiazepine Withdrawal) |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Haloperidol |
6.7 |
2.2 |
6.11-7.31 |
17% |
69% |
19% |
12% |
| 2nd Line: |
| 2 |
Risperidone |
6.3 |
2.5 |
5.56-6.94 |
|
62% |
23$ |
15% |
| 3 |
Olanzapine |
5.9 |
2.4 |
5.20-6.53 |
|
47% |
32% |
21% |
| 4 |
Quetiapine |
5.8 |
2.4 |
5.08-6.45 |
|
44% |
34% |
22% |
| 5 |
Ziprasidone |
3.9 |
2.6 |
3.17-4.64 |
|
25% |
25% |
50% |
| 6 |
Aripiprazole |
3.8 |
2.4 |
3.18-4.52 |
|
17% |
35% |
48% |
| 3rd Line: |
| 7 |
Benzo |
2.4 |
1.7 |
1.94-2.91 |
|
2% |
19% |
79% |
| 8 |
CPZ |
2.2 |
1.4 |
1.75-2.56 |
|
0% |
18% |
82% |
| 9 |
AChEI |
2.1 |
1.8 |
1.58-2.57 |
|
4% |
12% |
84% |
|
|
|
|
|
|
|
|
|
| Agitation, Psychosis, or Other Behavioral Manifestations of Dementia |
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Risperidone |
6.6 |
2.0 |
6.00-7.13 |
10% |
66% |
26% |
8% |
| 2 |
Quetiapine |
6.6 |
1.9 |
6.01-7.11 |
|
60% |
34% |
6% |
| 2nd Line: |
| 3 |
Olanzapine |
6.2 |
2.5 |
5.46-6.85 |
|
57% |
25% |
18% |
| 4 |
Haloperidol |
6.1 |
2.2 |
5.50-6.73 |
|
37% |
49% |
14% |
| 5 |
Aripiprazole |
5.0 |
2.5 |
4.26-5.70 |
|
32% |
38% |
30% |
| 6 |
Ziprasidone |
4.2 |
2.7 |
3.41-4.91 |
|
27% |
26% |
47% |
| 3rd Line: |
| 7 |
BZD |
3.1 |
2.5 |
2.40-3.80 |
|
14% |
21% |
65% |
| 8 |
AChEI |
2.5 |
2.3 |
1.98-3.25 |
|
8% |
17% |
75% |
| 9 |
CPZ |
2.3 |
1.6 |
1.80-2.72 |
|
0% |
26% |
74% |
|
|
|
|
|
|
|
|
|
SECTION II: NON-PHARMACOLOGICAL TREATMENT FOR DEPRESSION
|
Individual Therapy Modalities
|
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Supportive |
7.9 |
1.1 |
7.61-8.18 |
28% |
90% |
10% |
0% |
| 2 |
Psychoed |
7.7 |
1.5 |
7.28-8.04 |
|
93% |
4% |
3% |
| 3 |
CBT |
7.5 |
1.4 |
7.12-7.86 |
|
81% |
17% |
2% |
| 4 |
ITP |
7.2 |
1.7 |
6.73-7.62 |
|
77% |
18% |
5% |
| 5 |
Psychodyn |
6.6 |
2.0 |
6.10-7.16 |
|
58% |
31% |
11% |
| 2nd Line: |
|
|
|
|
|
|
|
|
|
| 3rd Line: |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Group Therapy Modalities
|
| Rank |
Name |
Mean |
SD |
95% CI |
TOC |
1st Line |
2nd Line |
3rd Line |
| 1st Line: |
| 1 |
Supportive |
7.4 |
1.9 |
6.94-7.96 |
26% |
81% |
12% |
7% |
| 2 |
Psychoed |
7.3 |
2.0 |
6.79-7.85 |
|
85% |
7% |
8% |
| 3 |
CBT |
7.0 |
2.1 |
6.47-7.53 |
|
77% |
15% |
8% |
| 4 |
Bereavement |
6.5 |
2.2 |
5.89-7.06 |
|
65% |
23% |
12% |
| 2nd Line: |
| 5 |
IPT |
6.3 |
2.5 |
5.67-7.00 |
|
66% |
16% |
18% |
| 6 |
Psychodyn |
5.6 |
2.4 |
4.98-6.26 |
|
45% |
31% |
24% |
| 3rd Line: |
|
|
|
|
|
|
|
|
|
