Psychiatric illnesses in patients with HIV infection and AIDS referred to the liaison psychiatrist

Article Abstract:

Infection with the human immunodeficiency virus (HIV), which is responsible for AIDS, is known to cause damage to the central nervous system early in its course. At the same time, the knowledge that one has contracted this fatal disease is bound to cause psychological stress, which may have severe repercussions in certain personalities. As a consequence of these two aspects of AIDS, a large number of patients develop psychiatric problems requiring attention. However, it is not a simple matter to determine which problems are the consequence of brain damage and which are the result of the psychological effects of simply having the disease. To examine the matter further, 60 patients diagnosed with HIV infection or AIDS who had been referred to a psychiatrist between July 1988 and July 1989 were studied. Most were male, and the majority (46) were homosexual. Of the patients referred, nine died within nine months, including one suicide. Depressive disorder was the most common complaint, affecting over half the patients. Among the patients with AIDS, affective disorders (disturbances in the stability of moods, and including depressive disorder) were most common. Fourteen patients with affective disorders had undergone CT scans, which revealed abnormalities of the brain in 11 instances. Overall, CT scans were available for 23 of the 60 patients, and abnormalities were detected in 17, a significant number. The available evidence suggests that the psychiatric illnesses for a large proportion of these patients were related to HIV-induced lesions, but further study of this is necessary. Patients with affective disorder were treated with lower-than-normal doses of antidepressants, as well as other (antiviral) medications and psychotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

AIDS patients

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HIV infection: psychiatric findings in the Netherlands

Article Abstract:

Acquired immune deficiency syndrome (AIDS), which is the clinical end-stage of infection with the human immunodeficiency virus (HIV), was first diagnosed in the Netherlands in 1982. Since 1983, approximately 270 patients have been admitted to a special HIV ward at the Academic Medical Centre near Amsterdam. Fifty-one of those admissions required a psychiatric consultation. The consultation notes were evaluated and analyzed for descriptive purposes. Forty patients had been diagnosed with AIDS and five with AIDS-related complex (symptoms of infection along with laboratory abnormalities, but without the typical opportunistic infections or cancers that characterize AIDS). The average age of the patients was 38 years. Forty-five were homosexual men; two men were bisexual; and three females and one male were intravenous drug users. Common reasons for requiring a psychiatric consultation were for depression or delirium, to make a differential diagnosis between depression and dementia, or to evaluate suicide risk. Organic brain syndrome was diagnosed in 41.2 percent of the patients. Twelve were diagnosed with major depression, although none were considered to be a suicidal risk. Thirteen were diagnosed with delirium, five with dementia, five with adjustment disorder, and two with atypical psychosis. The high incidence of AIDS referrals compared with patients from other wards indicates that psychiatric symptoms are common in HIV-related disease. Patients with AIDS-related dementia were less responsive to psychiatric interventions than depressed patients and often required low doses of antipsychotic medication to reduce agitation and anxiety. (Consumer Summary produced by Reliance Medical Information, Inc.)

Netherlands, Neurologic manifestations of general diseases, Neurologic manifestations

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Psychological aspects of HIV infection and AIDS: what have we learned?

Article Abstract:

Patients with AIDS may suffer a variety of adverse psychological effects as a result of their illness. Many homosexual men are stigmatized, intravenous drug users are condemned, and some people believe that those infected with the human immunodeficiency virus (HIV) are sexually promiscuous and fear that they will spread the disease. Despite programs aimed at reducing discrimination against people infected with HIV, prejudice is worldwide. Counselling is valuable to AIDS patients and the worried well - those who are not infected, but are unusually worried about their potential for infection. Newly infected individuals tend to seek out friends rather than family for support, and between 40 to 60 percent also seek psychiatric care. Suicide among AIDS patients is more common than previously estimated, and the highest risk period is the first six months after diagnosis. Cognitive decline has been seen as well, although this is reversible, in some cases, with drug therapy. Psychiatric care has played an important role in providing timely, supportive counseling to patients. In as much as these services have been successful, the use of psychiatric services today is much less than was once projected. This may be because earlier intervention leads to fewer psychiatric symptoms, therefore, requiring less severe intervention later on. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment

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