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. 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. 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. 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. 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. 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 person
WHO 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. 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. 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. 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. 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-up
WHO 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. 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. 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. 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. 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