Psychiatric disorders in people with HIV infection

 Toby Syme, Mark Jeanes  Victorian HIV Mental Health Service, Infectious Diseases Unit, The Alfred Hospital, Melbourne VIC Last reviewed: October 2019 Introduction People with human immunodeficiency virus (HIV) infection suffer high rates of mental illness. Epidemiological studies indicate that the prevalence of mental illness in this population may be as high as 47.9%. Common diagnoses …

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People with HIV infection suffer high rates of major depression. A meta-analysis found rates of major depression in HIV-positive people to be twice that of matched HIV-negative controls.[15] Rates may increase with HIV disease progression and symptomatic illness.[16] Certain risk factors are associated with an increased risk of depression: a personal or family history of mood disorders, …

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Anxiety symptoms are common in people with HIV infection, and are likely to be more prominent at times of significant life stresses and at stages of disease progression.[23] Anxiety disorders, where anxiety is severe and persistent, are also common: surveys have estimated the prevalence of generalised anxiety disorder to be up to 15% of HIV patients …

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Manic episodes are more common in people with HIV infection than in the general population.[27] An episode of mania is often associated with poor impulse control, impaired judgment and greater risk-taking behaviours, increasing the chance of contracting or spreading HIV infection. A manic episode may be primary (related to a bipolar disorder) or secondary to a …

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Acute changes in cognition – delirium Sudden changes in cognitive function raise the possibility of a diagnosis of delirium. The cardinal signs of delirium are fluctuating conscious state, impaired concentration and disorientation in time or place. As the course of illness is variable there may be periods of lucidity. There may also be associated psychotic …

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Substance abuse is a significant risk factor for the acquisition of HIV infection by direct means, such as sharing of injecting equipment, and indirect means such as risk behaviour associated with impaired judgment while intoxicated. Substance abuse is especially prevalent in people with HIV infection with reported rates ranging from 50-75%.[44] It is important to note …

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There is a complex association between the diagnosis of HIV infection and psychotic disorders, each potentially adversely affecting the other. The nature of a psychotic illness is such that it may significantly impair a patient’s capacity to participate in treatment. The diagnosis of a chronic psychosis is complex with symptoms divided into disorders of thought, …

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Clinicians require a good understanding of the role of psycho-active medications in the treatment of mental illness and also the high risk of potential drug-drug interactions and side effects in the population with HIV infection. Certain antiretroviral drugs, in particular protease inhibitors and NNRTIs, are metabolised primarily by the cytochrome P450 3A4 and 2D6 hepatic …

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Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry 2001; 58:721-8 Kelly B, Raphael B, Judd F, et al. Psychiatric disorder in HIV infection. Aust NZ J Psychiatry 1998; 32:441-53 Adewuya AO, Afolabi MO, Ola BA, et al. Psychiatric …

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