Substance-abuse disorders clinical presentation

An important related problem is the trend toward demedicalization of state mental health facilities. Given a host of clinical and economic realities, many HIV-infected patients can only be served by such institutions ( 472). Their complicated psychiatric and medical presentations, however, require a high level of clinical sophistication, particularly in recognizing and managing their physical co-morbidities ( 473, 474). Indeed, an increasing number of patients suffer from a triple diagnosis (i.e., a psychiatric disorder with co-morbid substance abuse and HIV-positive status) ( 475). 

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