The acute management of patients with psychiatric complications of chronic illness or chronic pain

Introduction: Patients with chronic medical problems often present to emergency departments (EDs) for acute management of psychiatric or psychological complications of their medical conditions. HIV, which can be considered a prototypical chronic illness, provides an example of the complexity of the acute evaluation and treatment of patients with chronic illness. In this chapter, HIV will serve as the chronic illness model, and the principles used to evaluate the psychiatric manifestations of HIV should serve as a reasonable illustration for the management of other chronic conditions. The psychiatric manifestations of a chronic illness such as HIV can be due to the virus itself, related to secondary opportunistic disorders in the face of immunosupression, or expressions of other problems that tend to be comorbid with HIV infection. Patients with chronic pain present with similar challenges in that their complaints can be the result of progression of underlying disease(s) that is/are the root of the pain, behavioral complications due to chronic pain itself, or comorbid disorders associated with chronic pain.