Psychiatric Complications                       www.aidsknowledgehub.org   Regional Knowledge Hub for the Care and Treatme...
The purpose of the session• The purpose of the session:  to discuss clinical features of the common psychiatric  complicat...
The Common Psychiatric Complications with HIV and AIDS •    Bipolar Disorder (Manic Depression) •    Delirium •    Grief (...
Bipolar Disorder                            (Manic Depression) • Diagnosis: Manic episodes and depressive   episodes and m...
Delirium • Diagnosis: Impaired consciousness, inability to   focus or sustain interest, cognitive changes,   global derang...
Patients with the mental                    problems. What to do?  • As far as possible, keep in a familiar environment  •...
Demoralization • Diagnosis: Exaggerated grief state, sad,   hopelessness, often precipitated by life   circumstances • Fre...
Grief (Normal state of low            mood focused on loss) • Treatment is psychological rather   than pharmacological (su...
Major Depression • Diagnosis: Depressed mood, loss of pleasure   from activities (anhedonia), anorexia, morning   insomnia...
Depression: Considerations for              home care  • Do no leave alone if suicide risk  • Provide counseling and suppo...
Obsessive Compulsive Disorder • Diagnosis: Recurrent obsessions   (preoccupying thoughts that the patient   finds irration...
Panic Attacks • Diagnosis: Recurring anxiety attacks   with fear plus somatic symptoms of   excitation lasting <1 hour • T...
Sleep Disturbance • Medications approval for insomnia have   potential for reinforcement and habituation • Cause: major de...
Substance Use Disorders • Diagnosis: Use of substances • Dependence: Persistent use or seeking   use, withdrawal, toleranc...
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Psychiatric complications eng_d5-1

  1. 1. Psychiatric Complications www.aidsknowledgehub.org Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia Advanced ART Training for Adults and Adolescents – Ukraine, 2004
  2. 2. The purpose of the session• The purpose of the session: to discuss clinical features of the common psychiatric complications in patients with HIV/AIDS and to learn the current recommendations for their diagnosis and treatment• Objectives: after completing this session, the participants will be able to: – Identify the common psychiatric complications in patients with HIV/AIDS – Describe clinical features of the common psychiatric complications in patients with HIV/AIDS – Provide a differential diagnosis for the common psychiatric complications in patients with HIV/AIDS – Evaluate the mental status of a patient with HIV/AIDS Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  3. 3. The Common Psychiatric Complications with HIV and AIDS • Bipolar Disorder (Manic Depression) • Delirium • Grief (normal state of low mood focused on loss) • Major Depression • Obsessive Compulsive Disorder • Panic Attacks • Sleep Disturbance • Substance Use Disorders (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  4. 4. Bipolar Disorder (Manic Depression) • Diagnosis: Manic episodes and depressive episodes and mixed episodes • Frequency: 9% of AIDS patients referred for psychiatric evaluation • Differential: Familial bipolar disorder and AIDS mania (no family history, no episodes prior to late stage HIV, co-morbid cognitive impairment • Treatment: Care should be directed by a psychiatrist (John G. Bartlett. Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  5. 5. Delirium • Diagnosis: Impaired consciousness, inability to focus or sustain interest, cognitive changes, global derangement of brain function, acute onset, altered consciousness, or disorganized thinking • Treatment: Correct underlying condition, which may be infection or medication related • Agitation: Neuroleptics such as haloperidol (Haldol) or risperidone • Agitation that puts others at risk: Neuroleptics + low dose of lorazepam for sedation (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  6. 6. Patients with the mental problems. What to do? • As far as possible, keep in a familiar environment • Keep things in the same place -easy to reach and see • Keep familiar time pattern to the days activities • Remove dangerous objects • Speak in simple sentences, one person at a time • Keep other noises down (such as TV, radio) • Make sure somebody is present to look after the sick personWHO HIV/AIDS Treatment and Care Protocols for countries of the Commonwealth of Independent States, March 2004 Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  7. 7. Demoralization • Diagnosis: Exaggerated grief state, sad, hopelessness, often precipitated by life circumstances • Frequency: 20% of AIDS patients referred for psychiatric evaluation • Differential: Often mistaken for depression, but unlike depression, often can enjoy some facets of life, feels best in the mornings and does not respond to antidepressants • Treatment: Psychotherapy • Response: is good and usually not to antidepressants (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  8. 8. Grief (Normal state of low mood focused on loss) • Treatment is psychological rather than pharmacological (support groups, buddy systems) (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  9. 9. Major Depression • Diagnosis: Depressed mood, loss of pleasure from activities (anhedonia), anorexia, morning insomnia or hypersomnia, difficulty concentrating, thoughts of suicide • Frequency: 20% of AIDS patients referred for psychiatric evaluation • Differential: Dementia, delirium, demoralization, intoxications or withdrawal, neurologic diseases • Treatment: Antidepressants • Response: rates to antidepressants is 85%; cure rate >50% (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  10. 10. Depression: Considerations for home care • Do no leave alone if suicide risk • Provide counseling and support: • Major depression: – Educate patient and family about medication – Refer for counseling if available – Ensure follow-up • Minor depression/complicated bereavement: – Counsel – Assist in finding solutions if sleep disturbed – Follow-upWHO HIV/AIDS Treatment and Care Protocols for Countries of the Commonwealth of Independent States, March 2004 Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  11. 11. Obsessive Compulsive Disorder • Diagnosis: Recurrent obsessions (preoccupying thoughts that the patient finds irrational and tries to resist) and/or compulsions (actions driven by obsessions to reduce anxiety) • Treatment: Refer to psychiatrist or a mental health specialist (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  12. 12. Panic Attacks • Diagnosis: Recurring anxiety attacks with fear plus somatic symptoms of excitation lasting <1 hour • Treatment: SSRI and refer to a psychiatrist (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  13. 13. Sleep Disturbance • Medications approval for insomnia have potential for reinforcement and habituation • Cause: major depression, mania, substance use disorder, demoralization • Treatment: refer for appropriate treatment to cause; insomnia temporally related to a specific stress (pre-op, grief etc.) may be treated with sedatives or hypnotics up to 1 week or with trazodone 25-150 mg hs for up to 4 weeks (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org
  14. 14. Substance Use Disorders • Diagnosis: Use of substances • Dependence: Persistent use or seeking use, withdrawal, tolerance, and physical dependence (John G. Bartlett, Medical Management of HIV Infection, 2003)Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia www.aidsknowledgehub.org

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