HIV RELATED PSYCHOSIS

KALULUSHI COLLEGE OF NURSING
Mr Mulundano M. L
BSCNs-UNZA
KCN-Lecture
HIV/AIDS RELATED
PSYCHOSIS

@KCN-Mulundano M. L
OBJECTIVES
• Define HIV/AIDS and Psychosis
• List some psychiatric conditions related
to HIV/AIDS infection
• Discuss the direct and indirect effect of
HIV/AIDS on mental health.
• Discuss the importance of HIV/AIDS in
mental
• Discuss the management of patients
with HIV/AIDS induced psychosis

@KCN-Mulundano M. L
Introduction
• A psychotic disorder is one which is
major in nature. This means the
mental illness is one in which a
patient experiences delusions and
hallucinations. Furthermore, the
patient is out of touch with reality.

@KCN-Mulundano M. L
Introduction cont’
• Due to the misperceptions (delusions
and hallucinations) he/she experiences
they imagine themselves to be
somebody else in another world, place
or situation of life. Psychotic symptoms
can be found in schizophrenia, mania,
depression and bi-polar affective
disorders.

@KCN-Mulundano M. L
Prevelence
• There is a strong link between mental illness
and HIV/AIDS;
• 50% or more of patients with HIV/AIDS have a
comorbid psychiatric disorder.
• The prevalence of mental illness in patients
with HIV/AIDS is reported to be 8 times higher
than in those without HIV/AIDS.
• Depression, bipolar disorder, anxiety
disorders, delirium, substance abuse, and
schizophrenia have all been identified in
persons receiving highly active antiretroviral
therapy (HAART).

@KCN-Mulundano M. L
Definitions
• HIV (human immunodeficiency virus) is a virus
that attacks cells that help the body fight
infection, making a person more vulnerable to
other infections and diseases.
• AIDS (acquired immunodeficiency syndrome).
Acquired immunodeficiency syndrome (AIDS)
is a chronic, potentially life-threatening
condition caused by the human
immunodeficiency virus (HIV)

@KCN-Mulundano M. L
• Psychosis is a symptom, not an illness.
A mental or physical illness, substance
abuse, or extreme stress or trauma can
cause it.
• It is defined as a condition that affects
the way the brain processes information.
It causes one to lose touch with reality.
You might see, hear, or believe things
that aren’t real

@KCN-Mulundano M. L
Effect of HIV/AIDS on
Mental Health
• Emotional distress
– Emotional distress is common in people
with HIV/AIDS for the following reasons:
• The nature of the AIDS physical symptoms
• Their progressive course
• The reactions of other people
• Some people at high risk for HIV (for example,
Drug abusers) have other psychological
problems

@KCN-Mulundano M. L
• Psychiatric problems, such as:
– Adjustment disorders,
– Depressive disorders
– Anxiety disorders,
– Suicide and deliberate self harm
– Neuropsychiatric disorders
– Social consequences
– Problems in relation to illicit drug use
– Ethical problems

@KCN-Mulundano M. L
• Psychiatric problems may occur to
people with:
– Long standing social difficulties
– Lack of social support
– Previous psychological problems

@KCN-Mulundano M. L
• Neurophysiological Disorders
• These are common due to immune
suppression and the direct effects of HIV
on the brain. This results into:
– Minor cognitive disorders common
– HIV associated dementia (AIDS-dementia
complex) is the most common and goes
undiagnosed.
– Patients given ARVs because it is AIDS
defining condition. Because it mostly occurs
with a CD4 less than 200.

@KCN-Mulundano M. L
– HIV encephalopathy – It is caused by the
HIV ‘virus’ itself.
– The virus attaches itself to the neurons in
the brain which leads to the encephalitis.
– Managed with appropriate ARVs. In most
cases these patients are taken to
psychiatrists because of these symptoms.
– Hence appropriate diagnosis must be made
to rule out HIV.

@KCN-Mulundano M. L
– Sub acute encephalitis occurs in 1/3 of
patients. Late in the illness
– Delirium may occur when there is an
opportunistic infection or cerebral
malignancy
– Psychosis is present in most of the above
neuropsychological disorders. This may
include psychiatric symptoms such as visual
hallucinations, delusions.

@KCN-Mulundano M. L
• There is a complex but significant
interaction between mental health and
HIV/AIDS.
• HIV affects mental health by its direct
neurobiological action, the impact of
having the illness, by its treatment
including that for opportunistic infections
and by its impact on the family

@KCN-Mulundano M. L
Effect of Mental illness
on HIV/AIDS
• Patients with HIV/AIDS and psychiatric
illness have a decreased quality of life,
poor adherence to medications, faster
disease progression, and increased
mortality.
• In some cases individuals with
psychiatric needs (victims of abuse, LD
persons) may be more vulnerable to
becoming infected with the virus.
•

@KCN-Mulundano M. L
Factors contributing to
Psychosis in HIV/AIDS.
• Factors contributing to Psychosis in HIV
infection rather than the direct effect og HIV
virus on the brain include;
– Opportunistic infections,
– CNS neoplasm,
– Medications,
– Substance use disorder and other
psychological stresses (McDaniel et al.,
2000).

@KCN-Mulundano M. L
DIFFICULTIES IN CARE
Care of these individuals is
complicated by;
• The stigma of HIV/AIDS and
• The prevalence of the illness in
underserved populations, as well as
• The need for complex medication
regimens and
• The possibility of drug–drug interactions
(DDIs).

@KCN-Mulundano M. L
MANAGEMENT
• A holistic approach is encouraged
–Socially
–Spiritually
–Physically
–Psychologically
Note: you have to consider the
complete person

@KCN-Mulundano M. L
MANAGEMENT
Some of the factors to consider:
• Drug interaction btn ARVs and
antipsychotics
• ARVs’ psychotic side effects
• Poor drug adherence by patient due
to possible paranoia regarding
medication.

@KCN-Mulundano M. L
– Medication side-effects and drug–drug interactions
are important considerations when patients are
prescribed antipsychotic agents for the treatment of
new-onset psychosis while concomitantly receiving
HAART.
– For example, the enzymatic inhibition seen
with protease inhibitors may lead to
increased serum levels of antipsychotic
agents and a greater potential for side-
effects

@KCN-Mulundano M. L
• Similarly, the ability of protease
inhibitors and some atypical
antipsychotic agents to cause
weight gain and dyslipidaemia may
lead to negative long-term outcomes
such as diabetes,
hypercholesterolemia, and
cardiovascular events.

@KCN-Mulundano M. L
• The ability of some antiretroviral agents
(for example, zidovudine, efavirenz) to
cause CNS effects (for example,
nightmares, hallucinations) may also
complicate the treatment of psychiatric
disorders. Caution should thus be
exercised when deciding on the
pharmacological treatment of psychosis
in HIV-infected individuals, (Nebhinani
and Mattoo, 2013).

@KCN-Mulundano M. L
• As patients with HIV-associated
psychosis are more sensitive to
extrapyramidal side effects, so they
require lower doses than other patients
with psychosis.
• The use of atypical antipsychotics in the
treatment of new-onset psychosis in HIV
positive persons has proven helpful in
reducing cases of extrapyramidal
symptoms.

@KCN-Mulundano M. L
• For example the use of risperidone
(1mg-3.3 mg), Olanzapine (10 mg)
and Clozapine (mean 27 mg) given
in smaller dosages minimize
extrapyramidal symptoms.

@KCN-Mulundano M. L
• These antipsychotics fall in the
Atypical(new generation
antipsychotics) while the old
generation antipsychotics also
called Typical antipsychotics follow
the same trend of smaller dosages(
that is, chlorpromazine, haloperidol,
trifluoperazine, thioridazine and
fluphenazine depot).

@KCN-Mulundano M. L
• Thus, since patients with HIV-
associated psychosis are more
sensitive to extrapyramidal side
effects, consequently they need
lower doses of antipsychotic drugs
than other patients’ with psychosis.

@KCN-Mulundano M. L
• Evaluation:
– The clinical evaluation of HIV-AIDS patients
with psychotic symptoms requires broad
history taking and physical examination, to
rule out other known causes of psychosis.
– A careful history should include information
about the onset and course of the patient’s
symptoms. Signs of medical illness, drug
intoxication, or medication toxicity should be
considered during the examination
(Nebhinani and Mattoo, 2013).

@KCN-Mulundano M. L
Nursing Care
Nursing aims
• To prevent injury
• To alley anxiety
• To prevent drug interaction and
there complications
• To help client reach there maximum
level of functioning independently.

@KCN-Mulundano M. L
Nursing Care
• If the patient is admitted to your ward or
hospital. You may focus your nursing
care on the following factors;
1. Environment of the patient
2. Psychological care
3. Nutritional status
4. Observations
5. Medication
6. Family therapy

@KCN-Mulundano M. L
Question?
• Why is HIV/AIDS of importance in
mental health? [30 marks]

HIV RELATED PSYCHOSIS

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