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Persons with HIV and other severe and complex medical illness referred for psychiatric evaluation deserve a comprehensive and empathic psychosocial assessment. A biopsychosocial approach to care considers each individual in the context of family, community, and society. Such an evaluation may have implications regarding health, coordinated care, adherence, and risk reduction. This chapter provides a review of the elements and process of a comprehensive psychiatric consultation in both the inpatient and outpatient settings. Some elements discussed include assessment of history and current psychiatric symptoms, illness, and care; alcohol and other drug use; suicidality; childhood and later trauma and intimate partner violence; spirituality; sexuality; sexual orientation; gender identity; sexual pleasure; and sexual health promotion. A comprehensive psychosocial and psychiatric examination also includes a complete cognitive evaluation and cultural formulation interview, and history of discrimination. Also addressed is the potential role of HIV-associated neurocognitive disorders in an individual’s psychiatric health.

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