Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
NEUROPSYCHIATRIC ASPECTS OF ACQUIRED IMMUNODEFICIENCY SYNDROME
AIDS and the Nervous System. Rosenblum ML et al, eds. New York, Raven Press, p. 315-25, 1988.. Unique Identifier : AIDSLINE ICDB/89648473 Ochitill HN; Dilley JW; Dept. of Psychiatry, San Francisco General Hosp., 1001 Potrero; Avenue, San Francisco, CA 94110
Abstract:
Neuropsychiatric dysfunction may precede, accompany, or follow the diagnosis of AIDS. Therefore, it is critical to understand the extent of neuropsychiatric disorder not only among AIDS patients (pts), but also among other groups that lie along the spectrum of AIDS illness. Neuropsychiatric aspects of AIDS are discussed, based mainly on clinical experience, anecdotal case reports, and a few organized studies. The major psychiatric disorders associated with AIDS (dementia, delirium, mood disorder associated with brain disease, and functional mental disorders) are described and a diagnostic approach is proposed. The neuropsychiatric effects of radiation therapy and chemotherapy are also discussed. Psychosocial and pharmacological intervention for psychiatric complications are summarized and future directions for clinical investigation are proposed. In addition to factors such as personality, history, and degree of social support available to the pt, the phase of illness must be considered in determining the approach to treatment. Once affective integration of the diagnosis occurs, at least partial control of the acute anxiety and dysphoria is achieved. Support of psychological defenses such as altruism and denial is also useful during the early period. Other important strategies for pts in the early stages of AIDS include relaxation training, hypnosis, and visualization. Treatment for pts in the terminal stages of AIDS is supportive and often involves working with the family, friends, and lovers, as well as with the pt. The pt should be encouraged to maintain interests, activities, and relationships that do not entail frustration or failure. Psychoactive medications should be used with caution, as pts with brain disease are more sensitive to their effects. Low starting doses and small increments are the rule. Nonpsychotic anxiety can be treated with benzodiazepines. Severe depressive symptoms can be helped with antidepressant medication, but it is desirable to choose drugs with minimal anticholinergic activity to avoid the risk of central anticholinergic psychosis and extra drying of mucous membranes. For agitation and psychotic symptoms, a high-potency antipsychotic medication such as haloperidol may be used. (38 Refs)
Keywords: Acquired Immunodeficiency Syndrome/COMPLICATIONS/*PSYCHOLOGY AIDS-Related Complex/PSYCHOLOGY Dementia/ETIOLOGY/PSYCHOLOGY Human Opportunistic Infections/ETIOLOGY/PSYCHOLOGY Organic Mental Disorders/ETIOLOGY/*PSYCHOLOGY Organic Mental Disorders, Substance-Induced/ETIOLOGY/PSYCHOLOGY Terminal Care/PSYCHOLOGY MONOGRAPH REVIEW, TUTORIAL REVIEW
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Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
