This document discusses HIV related psychosis. It defines HIV, AIDS, and psychosis. It then lists several potential causes of HIV related psychosis, including direct infection of the brain by HIV, opportunistic infections like meningitis and toxoplasmosis, hepatic encephalopathy, and drug induced psychosis from medications like efavirenz. Symptoms can include delusions, hallucinations, confusion, and memory loss. Management involves taking a history, investigations like HIV tests and lumbar puncture, and treatment based on the underlying cause such as antipsychotics for HIV induced psychosis or changing medications in cases of drug induced psychosis.

1. HIV RELATED PSYCHOSIS
BY PAULINE TEMBO(RN,BSC)

2. DEFINATIONS
• HIV:HIV (human immunodeficiency virus) is a virus that attacks the
body's immune system. If HIV is not treated, it can lead
to AIDS (acquired immunodeficiency syndrome).
• AIDS (acquired immunodeficiency syndrome):a disease in which there
is a severe loss of the body's cellular immunity, greatly lowering the
resistance to infection and malignancy
• PSYCHOSIS:A mental disorder characterised by a disconnection from
reality

3. CAUSES
1. HIV-1 can cross the blood-brain barrier (BBB) to penetrate
the brain and infect target cells, causing neurocognitive disorders as
a result of neuro-inflammation(encephalitis) and brain damage.
Manifestations of this include:
HIV INDUCED PSYCHOSIS: A mental disorder characterised by a
disconnection from reality. Possible symptoms include delusions,
hallucinations, talking incoherently and agitation.
HIV RELATED DEMENTIA: due to brain damage in the memory
centre, patient presents with forgetfulness, memory loss, confusion/
disorientation, as condition progresses, patient becomes mute.

4. 2.HIV RELATED OPPORTUNISTIC INFECTIONS/conditions- HIV lowers the immune
system which makes it easier for infections to easily affect the body. Examples of
infections that can cause psychosis are:
MENINGITIS-inflammation of the brain meninges caused by bacteria/ fungal
or protozoa. 80% of meningitis occurs in relation with HIV. Patients Present
With delusions, hallucinations and confusion.
 CEREBRAL TOXOPLASMOSIS, is an opportunistic infection caused by the
parasite Toxoplasma gondii. It typically affects patients with HIV/AIDS and is
the most common cause of cerebral abscess in these patients and altered
mental status
HEPATIC ENCEPHALOPATHY: The loss of brain function when a damaged liver
doesn't remove toxins from the blood.

5. 3. DRUG INDUCED PSYCHOSIS: patients who are on ART usually have
psychotic episodes especially those on Efavirenz-it gives patients vivid
dreams during the day as well hallucinations.
4. DEPRESSION: can occur due to failure to believe the results that have
been given to them or it could be due to pill burden.

6. MANAGEMENT
• HISTORY TAKING: ask the patients or relatives when
symptoms started, or if the patient is suffering from any
other disease
• INVESTIGATIONS: do liver function tests-to rule out liver
failure, HIV tests-to confirm diagnosis, Lumber puncture to
collect fluid for CSF analysis.

7. TREATMENT
Treatment is according to the cause:
• HIV induced psychosis- give anti psychotics such as artane and
haloperidol
• Meningitis: treat the causative organism ie in crytococal meningitis
give amphotericin B
• Drug Induced Psychosis: remove the causative drug ie efivarenz and
replace it with something less toxic
• Depression: give a mood stabilizer

8. Group assignment
• Peter daka, a 42 year old man, lives in kisasa has been referred with
delusions and hallucinations. The symptoms are believed to have
started when peter was started on ARVS.
TASK
perform a mental state examination