HIV Psychiatry Treatment Consensus Survey

Results

Brief Guide to Interpretation of Results Tables
Section I: Psychopharmacologic Treatments
Section II: Non-Pharmacological Treatment for Depression
- Individual Therapy Modalities
- Group Therapy Modalities

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

Rank	Name	Mean	SD	95% CI	TOC	1st Line	2nd Line	3rd Line
Newly Diagnosed HIV and HAART-Naive
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:

Results

Brief Guide to Interpretation of Results Tables

SECTION I: PSYCHOPHARMACOLOGIC TREATMENTS

Choice of First-Line Antidepressants

Ineffective Initial Antidepressant

Duration of Antidepressant Treatment

Frequency of Follow-Up

Antipsychotic Choice for Psychosis (Unrelated to Dementia or Delirium)

Choice of Benzodiazepines for Anxiety Disorders

Treatment of Mania

Treatment of Cognitive Disorders

SECTION II: NON-PHARMACOLOGICAL TREATMENT FOR DEPRESSION

Individual Therapy Modalities

Group Therapy Modalities