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## Complete Summary

#### GUIDELINE TITLE

Anxiety disorders in patients with HIV/AIDS. Mental health care for
people with HIV infection.

#### BIBLIOGRAPHIC SOURCE(S)

Anxiety disorders in patients with HIV/AIDS. In: Mental health care for
people with HIV infection: HIV clinical guidelines for the primary care
practitioner. New York (NY): New York State Department of Health; 2006
Mar. p. 1-8. \[1 reference\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Anxiety disorders in patients
with HIV/AIDS. In: Mental health care for people with HIV infection: HIV
clinical guidelines for the primary care practitioner. New York (NY):
New York State Department of Health; 2001 Mar. p. 59-68.

### \*\* REGULATORY ALERT \*\*

#### FDA WARNING/REGULATORY ALERT

**Note from the National Guideline Clearinghouse**: This guideline
references a drug(s) for which important revised regulatory information
has been released.

-   [May 2, 2007, Antidepressant
    drugs](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Antidepressant):
    Update to the existing black box warning on the prescribing
    information on all antidepressant medications to include warnings
    about the increased risks of suicidal thinking and behavior in young
    adults ages 18 to 24 years old during the first one to two months of
    treatment.

-   [March 14, 2007, Sedative-hypnotic drug
    products](http://www.fda.gov/medwatch/safety/2007/safety07.htm#Sedative):
    Revisions to product labeling to include stronger language
    concerning potential risks including severe allergic reactions and
    complex sleep-related behaviors, such as sleep-driving.

-   [October 25, 2006, Effexor (venlafaxine
    HCl)](http://www.fda.gov/medwatch/safety/2006/safety06.htm#Effexor):
    Published retrospective studies report that venlafaxine overdosage
    may be associated with an increased risk of fatal outcome.

### COMPLETE SUMMARY CONTENT

 \*\* REGULATORY ALERT \*\*\
 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

-   Human immunodeficiency virus infection/acquired immune deficiency
    syndrome (HIV/AIDS)

-   Anxiety disorders, including:

    -   Panic attacks and disorder

    -   Phobias

    -   Generalized anxiety disorder

    -   Obsessive-compulsive disorder

    -   Acute stress disorder

    -   Post-traumatic stress disorder

    -   Adjustment disorder with anxious mood

#### GUIDELINE CATEGORY

Diagnosis\
Management\
Treatment

#### CLINICAL SPECIALTY

Allergy and Immunology\
Family Practice\
Infectious Diseases\
Internal Medicine\
Psychiatry\
Psychology

#### INTENDED USERS

Advanced Practice Nurses\
Health Care Providers\
Physician Assistants\
Physicians\
Public Health Departments

#### GUIDELINE OBJECTIVE(S)

To provide guidelines for diagnosis and treatment of anxiety disorders
in patients with human immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS) in primary care settings

#### TARGET POPULATION

Patients with human immunodeficiency virus/acquired immune deficiency
syndrome (HIV/AIDS) in primary care settings with suspected anxiety
disorder

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Diagnosis**

1.  Consideration of signs and symptoms

2.  Distinguishing among anxiety disorders and excluding underlying
    medical conditions such as human immunodeficiency virus
    (HIV)-related central nervous system disease, endocrinopathies,
    cardiovascular and other conditions that may cause anxiety

3.  Reviewing patients\' medication regimens and obtaining a thorough
    substance use history

**Treatment/Management**

1.  Referring patients who use substances or whose anxiety is persistent
    or severe and does not respond to standard treatment to mental
    health professionals

2.  Providing psychological support

3.  Medications, including benzodiazepines, selective serotonin
    re-uptake inhibitors (SSRIs), and tricyclic antidepressants

#### MAJOR OUTCOMES CONSIDERED

Not stated

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Expert Consensus (Committee)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

The Human Immunodeficiency Virus (HIV) Guidelines Program works directly
with committees composed of HIV Specialists to develop clinical practice
guidelines. These specialists represent different disciplines associated
with HIV care, including infectious diseases, family medicine,
obstetrics and gynecology, among others. Generally, committees meet in
person 3 to 4 times per year, and otherwise conduct business through
monthly conference calls.

Committees meet to determine priorities of content, review literature,
and weigh evidence for a given topic. These discussions are followed by
careful deliberation to craft recommendations that can guide HIV primary
care practitioners in the delivery of HIV care. Decision making occurs
by consensus. When sufficient evidence is unavailable to support a
specific recommendation that addresses an important component of HIV
care, the group relies on their collective best practice experience to
develop the final statement. The text is then drafted by one member,
reviewed and modified by the committee, edited by medical writers, and
then submitted for peer review.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

**Key Point**:

Patients with limited social support may be particularly susceptible to
developing anxiety symptoms.

**Clinical Presentation**

Clinicians should consider the diagnosis of an anxiety disorder when a
patient presents with common somatic symptoms, such as chest pain,
diaphoresis, dizziness, gastrointestinal disturbances, and/or headache,
for which no underlying medical etiology can be established.

**Diagnosis**

**Differential Diagnosis**

*Other Mental Health Disorders and Medical Conditions*

Clinicians should exclude other mental health disorders in patients who
present with anxiety.

Clinicians should exclude medical conditions, including human
immunodeficiency virus (HIV)-related central nervous system disease, in
patients who present with anxiety.

Clinicians should review medication regimens and substance use history
in patients with anxiety.

Refer to Table 1 in the original guideline document for medications that
may cause anxiety-like symptoms in HIV patients.

**Anxiety Disorders**

See Figure 1 in the original guideline document for a structured
approach to distinguishing among anxiety disorders.

**Management of HIV-Infected Patient with Anxiety Disorders**

Clinicians should refer patients with symptoms of anxiety to a
psychiatrist for evaluation and possible ongoing treatment when:

-   Anxiety symptoms do not respond to standard pharmacologic treatment
    or basic supportive/behavioral interventions.

-   The diagnosis of an anxiety disorder is difficult to establish

-   Anxiety is persistent or severe.

-   Patients with obsessive-compulsive disorder have intrusive or
    disturbing thoughts or compulsive rituals that are poorly controlled
    with the current medication or that cause the patient marked
    subjective distress.

-   Anxiety occurs in patients with a significant substance use history
    or in those who are actively using substances.

**Psychological/Supportive Intervention in the Primary Care Setting**

Refer to the original guideline document for a discussion of specific
supportive strategies.

**Key Point**:

Basic supportive and behavioral interventions are sufficient to
alleviate anxiety in certain patients.

**Pharmacologic Interventions in the Primary Care Setting**

Clinicians should be familiar with the safety profiles of medications
used to treat anxiety and how these medications may interact with those
used in the treatment of HIV disease. (Refer to Table 1 in Appendix I of
the companion document: Interactions Between HIV-Related Medications and
Psychotropic Medications: Indications and Contraindications.)

*General Principles in the Pharmacologic Treatment of Anxiety Disorders
and Their Symptoms*

No single medication will treat the spectrum of symptoms seen in
patients with anxiety disorders. The following general principles will
help determine the pharmacologic intervention that is most likely to be
helpful (see Table, below).

-   [Panic Attacks/Panic Disorder]{.underline}\--In general, while
    symptomatic relief for patients experiencing panic attacks can
    usually be accomplished with the short-term use of benzodiazepines,
    selective serotonin reuptake inhibitors (SSRIs) are the treatment of
    choice because they effectively prevent panic attacks from
    recurring. Given the morbidity associated with ongoing panic
    attacks, it is important to give prophylaxis to prevent recurrence.
    Venlafaxine is also effective in preventing panic attacks, as well
    as the tricyclic antidepressants, but the latter are limited in
    their usage due to their side-effect profiles and potential for
    drug-drug interactions.

-   [Generalized Anxiety Disorder]{.underline}\--Patients with chronic
    anxiety, consistent with generalized anxiety disorder, may require
    long-term therapy with medication. Buspirone should be considered
    because it is an effective anxiolytic that has no potential for
    abuse, which is particularly important for patients with a history
    of substance use. The SSRIs and venlafaxine can also be effective in
    some patients with persistent anxiety. Although some patients may
    experience relief sooner, the onset of action of buspirone (3-6
    weeks) and SSRIs (2-4 weeks) may necessitate the short-term use of
    benzodiazepines; however, these should be used with caution, because
    of the potential for dependence in some patients.

-   [Adjustment Disorder]{.underline}\--Short-term symptomatic relief
    may be helpful in some patients. A time-limited use (2-4 weeks) of
    benzodiazepines prescribed on a daily or as-needed basis can be
    effective.

-   [Post-Traumatic Stress Disorder (PTSD)]{.underline}\--See the New
    York State Department of Health AIDS Institute guideline \"Trauma
    and Post-Traumatic Stress Disorder in Patients with HIV/AIDS.\"

-   [Insomnia]{.underline}\--Insomnia is an important symptom to treat
    because it often causes impaired daily function. If an underlying
    medical etiology or chemical cause has been excluded, insomnia
    should almost always be considered a symptom of an underlying
    psychiatric disorder (major depression, adjustment disorder,
    generalized anxiety disorder, PTSD). Diagnosis and treatment of the
    underlying condition is essential and often results in resolution of
    the insomnia. Nonpharmacologic approaches to treating insomnia
    should be tried before prescribing medications. See Chapter
    \"Somatic Symptoms\" in the original guideline document for
    recommendations on treating insomnia.

**Table. Commonly Used Psychotropic Medications in the Treatment of
Anxiety Disorders and Anxiety Symptoms**

+---------------------------------+------------------------------------+
| **Disorder or Symptom**         | **Medication or Medication Class** |
+=================================+====================================+
| Panic disorder                  | SSRIs                              |
|                                 |                                    |
|                                 | -   Citalopram                     |
|                                 |                                    |
|                                 | -   Escitalopram                   |
|                                 |                                    |
|                                 | -   Sertraline                     |
|                                 |                                    |
|                                 | -   Paroxetine                     |
|                                 |                                    |
|                                 | -   Fluoxetine                     |
|                                 |                                    |
|                                 | Tricyclics                         |
|                                 |                                    |
|                                 | -   Nortriptyline                  |
|                                 |                                    |
|                                 | -   Desipramine                    |
|                                 |                                    |
|                                 | -   Doxepin                        |
|                                 |                                    |
|                                 | -   Imipramine                     |
|                                 |                                    |
|                                 | Benzodiazepines                    |
|                                 |                                    |
|                                 | -   Lorazepam                      |
|                                 |                                    |
|                                 | -   Alprazolam                     |
|                                 |                                    |
|                                 | -   Clonazepam                     |
|                                 |                                    |
|                                 | Other                              |
|                                 |                                    |
|                                 | -   Venlafaxine                    |
+---------------------------------+------------------------------------+
| Generalized anxiety disorder    | Buspirone\                         |
|                                 | \                                  |
|                                 | SSRIs (listed above)               |
+---------------------------------+------------------------------------+
| Obsessive-compulsive disorder   | SSRIs (listed above)\              |
|                                 | \                                  |
|                                 | Other                              |
|                                 |                                    |
|                                 | -   Fluvoxamine                    |
|                                 |                                    |
|                                 | -   Clomipramine                   |
|                                 |                                    |
|                                 | -   Venlafaxine                    |
+---------------------------------+------------------------------------+
| Adjustment disorder with        | Benzodiazepines (listed above)     |
| anxious mood                    |                                    |
+---------------------------------+------------------------------------+
| Insomnia\*                      | Zolpidem\                          |
|                                 | \                                  |
|                                 | Benzodiazepines (listed above) and |
|                                 | temazepam\                         |
|                                 | \                                  |
|                                 | Other                              |
|                                 |                                    |
|                                 | -   Trazodone                      |
|                                 |                                    |
|                                 | -   Doxepin                        |
+---------------------------------+------------------------------------+
| PTSD                            | SSRIs (listed above)\*\*           |
+---------------------------------+------------------------------------+
| Major depression with           | SSRIs (listed above)\              |
| significant anxiety\*\*\*       | \                                  |
|                                 | Benzodiazepines (listed above)\    |
|                                 | \                                  |
|                                 | Other                              |
|                                 |                                    |
|                                 | -   Venlafaxine                    |
|                                 |                                    |
|                                 | -   Tricyclics (listed above)      |
+---------------------------------+------------------------------------+

\*Nonpharmacologic approaches should be attempted before treatment with
medication. See Chapter \"Somatic Symptoms\" in the original guideline
document.

\*\*Sertraline and paroxetine are the only U.S. Food and Drug
Administration (FDA)-approved medications for PTSD. However, all SSRIs
(in the same doses used for depression) are helpful in treating symptoms
of depression and anxiety. See the New York State Department of Health
AIDS Institute guideline Trauma and Post-Traumatic Stress Disorder in
Patients with HIV/AIDS.

*Treatment of Anxiety Disorders in Substance Users*

Primary care clinicians should coordinate with a psychiatrist and/or
addiction specialist when managing anxiety disorders among patients with
substance use disorders. A psychiatric evaluation of these patients
should be performed.

Clinicians should discuss the long-term risks of dependence, withdrawal,
and abuse, as well as the intended course of treatment, with patients
with substance use disorders or a history of substance use disorders
before benzodiazepines or other controlled substances are used to treat
an anxiety disorder.

Clinicians should make the decision to withhold benzodiazepines on a
case-by-case basis, weighing the risks and benefits for patients with
substance use disorders.

#### CLINICAL ALGORITHM(S)

An algorithm is provided in the original guideline document for
\"Distinguishing Anxiety Disorders.\"

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is not specifically stated for each
recommendation.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate diagnosis and management of anxiety disorders in patients
with human immunodeficiency virus/acquired immunodeficiency syndrome
(HIV/AIDS)

#### POTENTIAL HARMS

-   Benzodiazepines should be used with caution because of the potential
    for dependence and abuse in some patients.

-   The use of tricyclic antidepressants is limited due to their
    side-effect profile and potential for drug-drug interactions.

Refer to Table 1 in Appendix I (see \"Availability of Companion
Documents\" field) for interactions between HIV-related medications and
psychotropic medications: indications and contraindications.

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

Refer to Table 1 in Appendix I (see \"Availability of Companion
Documents\" field)  for a list of contraindicated drug combinations.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

Following the development and dissemination of guidelines, the next
crucial steps are adoption and implementation. Once practitioners become
familiar with the content of guidelines, they can then consider how to
change the ways in which they take care of their patients. This may
involve changing systems that are part of the office or clinic in which
they practice. Changes may be implemented rapidly, especially when clear
outcomes have been demonstrated to result from the new practice such as
prescribing new medication regimens. In other cases, such as diagnostic
screening, or oral health delivery, however, barriers emerge which
prevent effective implementation. Strategies to promote implementation,
such as through quality of care monitoring or dissemination of best
practices, are listed and illustrated in the companion document to the
original guideline (*HIV clinical practice guidelines*, New York State
Department of Health; 2003), which portrays New York\'s HIV Guidelines
Program. The general implementation strategy is outlined below.

-   Statement of purpose and goal to encourage adoption and
    implementation of guidelines into clinical practice by target
    audience.

-   Define target audience (providers, consumers, support service
    providers).

    -   Are there groups within this audience that need to be identified
        and approached with different strategies (e.g., HIV Specialists,
        family practitioners, minority providers, professional groups,
        rural-based providers)?

-   Define implementation methods.

    -   What are the best methods to reach these specific groups (e.g.,
        performance measurement consumer materials, media, conferences)?

-   Determine appropriate implementation processes.

    -   What steps need to be taken to make these activities happen?

    -   What necessary processes are internal to the organization (e.g.,
        coordination with colleagues, monitoring of activities)?

    -   What necessary processes are external to the organization (e.g.,
        meetings with external groups, conferences)?

    -   Are there opinion leaders that can be identified from the target
        audience that can champion the topic and influence opinion?

-   Monitor progress.

    -   What is the flow of activities associated with the
        implementation process and which can be tracked to monitor the
        process?

-   Evaluate.

    -   Did the processes and strategies work?

    -   Were the guidelines implemented?

    -   What could be improved in future endeavors?

#### IMPLEMENTATION TOOLS

Clinical Algorithm\
Personal Digital Assistant (PDA) Downloads\
Resources

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Anxiety disorders in patients with HIV/AIDS. In: Mental health care for
people with HIV infection: HIV clinical guidelines for the primary care
practitioner. New York (NY): New York State Department of Health; 2006
Mar. p. 1-8. \[1 reference\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2001 Mar (revised 2006 Mar)

#### GUIDELINE DEVELOPER(S)

New York State Department of Health - State/Local Government Agency
\[U.S.\]

#### SOURCE(S) OF FUNDING

New York State Department of Health

#### GUIDELINE COMMITTEE

Mental Health Guidelines Committee

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee Chair*: Francine Cournos, MD, Professor of Clinical
Psychiatry, Columbia University, New York State Psychiatric Institute -
Unit 112, New York, NY

*Committee Vice-Chair*: Milton L Wainberg, MD, Associate Professor of
Clinical Psychiatry, New York State Psychiatric Institute \-- Unit 112,
New York, NY

*AIDS Institute Liaison*: L. Jeannine Bookhardt-Murray, MD, Medical
Director, Harlem United, New York, NY

*AIDS Institute Representatives*: Teresa C. Armon, RN, MS, Assistant
Bureau Director of Community Support Services, New York State Department
of Health, AIDS Institute, Albany, NY; Heather A Duell, LMSW, Director
of Mental Health, Bureau of Community and Support Services, New York
State Department of Health, AIDS Institute, Albany, NY

*Committee Members*: Bruce D Agins, MD, MPH, Assistant Professor of
Medicine, Cornell University Medical College, New York, New York; Philip
A Bialer, MD, Associate Professor of Clinical Psychiatry, Albert
Einstein College of Medicine, Chief, Division of Consultation-Liaison
Psychiatry, Beth Israel Medical Center, New York, NY; John M Budin, MD,
Clinical Instructor in Psychiatry, Columbia University College of
Physicians and Surgeons, New York, NY; Mary Ann Cohen, MD, Director,
AIDS Psychiatry, Associate Professor of Psychiatry, Mount Sinai Medical
Center, New York, NY; Barbara A Conanan, RN, MS, SRO/Homeless Program
Director, Saint Vincent\'s Catholic Medical Centers, Saint Vincent\'s
Manhattan Department of Community Medicine, New York, NY; John AR
Grimaldi, Jr, MD, Assistant Professor of Clinical Psychiatry, Sanford
Weill-Cornell University Medical College, New York, NY, Chief
Psychiatrist, David Rodgers Unit, Center for Special Studies, New York
Presbyterian Hospital-Weill Cornell Medical Center, New York, NY; Yiu
Kee (Warren) Ng, MD, Director, Special Needs Clinic, New York
Presbyterian Hospital, Columbia University Medical Center, New York, NY;
Francine Rainone, DO, Director of Community Palliative Care, Montefiore
Medical Center, Department of Family Medicine, Bronx, NY

*Liaison*: James J Satriano, PhD, Director of HIV/AIDS Programs, New
York State Office of Mental Health, New York, New York, Assistant
Professor of Clinical Psychology, Department of Psychiatry, Columbia
University College of Physicians and Surgeons, New York, NY

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Anxiety disorders in patients
with HIV/AIDS. In: Mental health care for people with HIV infection: HIV
clinical guidelines for the primary care practitioner. New York (NY):
New York State Department of Health; 2001 Mar. p. 59-68.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [New York State Department of
Health AIDS Institute Web
site](http://www.hivguidelines.org/Content.aspx?pageID=261).

Print copies: Available from Office of the Medical Director, AIDS
Institute, New York State Department of Health, 5 Penn Plaza, New York,
NY 10001; Telephone: (212) 268-6108

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   Appendix I: interactions between HIV-related medications and
    psychotropic medications: indications and contraindications. New
    York (NY): New York State Department of Health; 2001 Mar. Electronic
    copies: Available from the [New York State Department of Health AIDS
    Institute Web
    site](http://www.hivguidelines.org/public_html/center/clinical-guidelines/mental_health_guidelines/mental_health/supp_html_files/mental_health_page8.htm).

-   Appendix II: HIV-related causes of psychiatric symptoms:
    differential diagnosis. New York (NY): New York State Department of
    Health; 2001 Mar. Electronic copies: Available from the [New York
    State Department of Health AIDS Institute Web
    site](http://www.hivguidelines.org/public_html/center/clinical-guidelines/mental_health_guidelines/mental_health/supp_html_files/mental_health_page8.htm).

-   Appendix III: rating scales. New York (NY): New York State
    Department of Health; 2001 Mar. Electronic copies: Available from
    the [New York State Department of Health AIDS Institute Web
    site](http://www.hivguidelines.org/public_html/center/clinical-guidelines/mental_health_guidelines/mental_health/supp_html_files/mental_health_page8.htm).

-   Appendix IV: mental health care resources in New York State. New
    York (NY): New York State Department of Health; 2001 Mar. Electronic
    copies: Available from the [New York State Department of Health AIDS
    Institute Web
    site](http://www.hivguidelines.org/public_html/center/clinical-guidelines/mental_health_guidelines/mental_health/supp_html_files/mental_health_page8.htm).

-   Appendix V: syringe access resources in New York State. New York
    (NY): New York State Department of Health; 2001 Mar. Electronic
    copies: Available from the [New York State Department of Health AIDS
    Institute Web
    site](http://www.hivguidelines.org/public_html/center/clinical-guidelines/mental_health_guidelines/mental_health/supp_html_files/mental_health_page8.htm).

-   Appendix VI: permanency planning and transitional services. New York
    (NY): New York State Department of Health; 2001 Mar. Electronic
    copies: Available from the [New York State Department of Health AIDS
    Institute Web
    site](http://www.hivguidelines.org/public_html/center/clinical-guidelines/mental_health_guidelines/mental_health/supp_html_files/mental_health_page8.htm).

Print copies: Available from Office of the Medical Director, AIDS
Institute, New York State Department of Health, 5 Penn Plaza, New York,
NY 10001; Telephone: (212) 268-6108

This guideline is available as a Personal Digital Assistant (PDA)
download from the [New York State Department of Health AIDS Institute
Web site](http://hivguidelines.org/Content.aspx?pageID=261).

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on May 5, 2005. It was updated by
ECRI on April 13, 2006. This summary was updated by ECRI on November 22,
2006, following the FDA advisory on Effexor (venlafaxine HCl). This
summary was updated by ECRI Institute on April 30, 2007, following the
FDA advisory on Sedative-hypnotic drug products. This summary was
updated by ECRI Institute on November 9, 2007, following the U.S. Food
and Drug Administration advisory on Antidepressant drugs.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is
copyrighted by the guideline developer. See the [New York State
Department of Health AIDS Institute Web
site](http://www.hivguidelines.org/public_html/terms_of_use.htm) for
terms of use.

### DISCLAIMER

#### NGC DISCLAIMER

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Date Modified: 11/3/2008