The document discusses mental health issues associated with HIV/AIDS. It notes that individuals with HIV are at increased risk of developing mental disorders due to biological factors like neurological impairment, as well as psychosocial factors such as stigma, grief, lack of support, and prior psychological difficulties. Common mental health problems in HIV+ individuals include depression, anxiety, adjustment disorders, substance abuse, and dementia. Psychiatric medications used to treat HIV can also cause side effects like mood changes. Interventions include counseling, education, and pharmacological treatments.

1. The Psychiatry of HIV Infection
Dr Ajay Nihalani
MD,MRCPsych
www.nihalaniclinics.com,www.drnihalanipsychiatristd
elhi.com

2. Mental Disorders in HIV infection
Similar to other potentially serious conditions
Include…normal psychological reactions
Eg.shock,denial,distress
Abnormal responses..suicidal behavior and major depression
Neuropsychiatric complications eg dementia
HIV infected individuals at increased risk of developing mental health problems
h/o psychological & social difficulties prior to acquiring HIV
SOCIAL STIGMA associated with HIV/AIDS adds to the physical consequences

3. Factors associated with development of mental
disorders in HIV
HIV related factors---notofication of HIV infection,decline in health,AIDS
diagnosis,disabling symptoms.
h/o psychiatric problems
Lack of social supports
Avoidance & Denial as a habitual way of coping
Exposure to grief d/t AIDS & other adverse life events
Personal characteristics:age,reduced brain reserve,gender.

4. Types of mental disorders in HIV/AIDS
Abnormal psychological reactions-adjustment disorders,manifestations of
personality disorder
Mood and other disorders-major depression,suicidal bahaviour,manic
episodes,sexual dysfunction,anxiety disorders,obsessive compulsive disorder,eating
disorders,
Organic brain syndromes—acute and subacute brain syndromes,HIV ass.
Dementia,HIV associated minor cognitive impairement
Mental disorders in partners and relatives
Abnormal beliefs in people seeking testing for HIV

5. Abnormal psychological reactions
Anxiety,Insomnia,Depressive Sx.
Adjustment disorder in 30%
Personality disorder manifestations….eg avoidant,dependent,narcissistic,histrionic
Worsened by substance misuse

6. Mood Disorders
Depression prevalene 80%..often unrecognized or insufficiently treated
Mania…inherent & iatrogenic causes,underlying BPAD
New onset mania in severe symptomatic disease is predictive of reduced survival
Sexual dysfunction…psychological,organic,iatrogenic

7. Organic brain Syndromes
Sec. to immune suppression…opportunistic infections,progressive multifocal
leucoencephalopathy,cerebral lymphoma
Delirium…acute and subacute d/t systemic disorder,sec complx

8. HIV Dementia
Substantial memory and intellectual decline
Marked psychomotor slowing
Motor abnormalities
Develops over a rel short period of time,associated with poor
prognosis
Minor cognitive disorder
Poorer memory &attention,slower information processing,difficulty
with abstract thinking

9. Mental disorders of partners and relatives
Adapt to the changed relationship
Increased dependency
Declining health
Fear of infection
Social stigma

10. Abnormal beliefs in people seeking testing for HIV
Remain concerned,convinced they are seropositive
Seek repeated testing
May point to underlying neurotic disorders,inadequate information,mistaken
attitudes to delusions

11. Assessment of Mental Health Problems
Recognition by those involved in treatment and care
Avoidance of attributing it to the disease
Or as a normal &understandable reaction
Avoidance of negative attitudes

12. Interventions
Ensuring appropriate counseling
Pretest ….significance of the procedure
Post test….outcome
Risk reduction counseling
Use of psychoeducational techniques,psychotherapy,psychopharmacological
interventions

13. Agent Psychiatric side-effects
For additional information see Everall et al, 2004, and the following websites: Clinical Care
Options for HIV (www.clinicaloptions.com/hiv); the National AIDS Manual (www.aidsmap.com
); AIDSinfo (AIDSinfo.nih.gov).
Protease inhibitors
Amprenavir Mood changes
Indinavir Mood changes
Lopinavir+ritonavir Mood changes, agitation, anxiety
Nelfinavir None reported
Ritonavir Anxiety
Saquinavir Depression, anxiety, sleep disturbances
Atazanavir Depression, insomnia
Fosamprenavir None reported
Nucleoside reverse transcriptase inhibitors (NRTIs)
Abacavir None reported
Didanosine
Lethargy, nervousness, anxiety, confusion, sleep
disturbances, mood disorders, psychosis
Lamivudine Insomnia, mood disorders
Stavudine Sleep and mood disorders, delirium
Zalcitabine
Somnolence, impaired concentration, mood
disorders, delirium
Zidovudine
Sleep disturbance, vivid dreams, agitation, mania
and depression, psychotic symptoms, delirium
Coformulated NRTIs
Zidovudine+lamivudine See above
Zidovudine+lamivudine+ abacavir See above
Nucleotide reverse transcriptase inhibitors (NtRTI)
Tenofovir None reported
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Delavirdine None reported
Efavirenz
Agitation, depersonalisation, hallucinations,
disturbed dreams, mood disorders, depression,
suicidality, antisocial behaviour, psychosis,
catatonia, delirium
Nevirapine None reported
Fusion or entry inhibitors
Enfuvirtide Anxiety, depression
Common psychiatric side-effects of licensed antiretroviral agents

15. Lord,
I'm glad I can talk to you.
You’re always there -
even when my head is somewhere else.
Sometimes I feel overwhelmed
ashamed, afraid to face the future.
It’s hard living with a stigma.
It’s not what people say.
It’s what they don't say.
It’s the knowing smiles,
and the sheepish looks.
They all add up to a feeling of accusation.
Lord,
I’m glad I can talk to you
Nothing surprises you.
You’ve been where I’ve been
You’ve felt the discrimination
Experienced the betrayal
the hurt
the name calling
the whispering in corners
the prejudice.
Lord,
You make me feel whole again
You include me in
You make me feel understood
Your extravagant generosity
leaves me speechless.
Words fail me as I try to say
Thank you
You draw me
You give me a place in the picture
You tell me
I belong even when I can't believe.
Lord, you’re unbelievable!
Thank You