1 / 39

Things you need to know about HIV Psychiatry

In perspective: Death by AIDS <13 yrs old = 5,071 >13 yrs old = 496,598 MSM>IVU>MSM/IVU>HET Female causes: IVU>HET. Living with HIV/AIDS <13 yrs old = 3,219 >13 yrs old = 308,914 Bl not HISP>WT not HISP>HISP MSM>IVU>HET>MSM/IVU Female causes: HET>IDU . In Florida

art
Download Presentation

Things you need to know about HIV Psychiatry

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Things you need to know about HIV Psychiatry German Molina, M.D. Assistant Professor of Clinical Psychiatry University of Miami

    2. In perspective: Death by AIDS <13 yrs old = 5,071 >13 yrs old = 496,598 MSM>IVU>MSM/IVU>HET Female causes: IVU>HET

    3. Living with HIV/AIDS <13 yrs old = 3,219 >13 yrs old = 308,914 Bl not HISP>WT not HISP>HISP MSM>IVU>HET>MSM/IVU Female causes: HET>IDU

    4. In Florida Living with HIV <13 yrs old = 244 >13 yrs old = 28,945 Total = 29,189 Living with AIDS <13 yrs old = 408 >13 yrs old = 40,607 Total = 41,015

    5. In Florida Living with HIV and AIDS Total = 70,204 And Worldwide 42 millions.

    6. HIV is a Psychiatric Epidemic HIV increases risk for psychiatric illness Psychiatric illness increases risk for HIV Effective treatment for psychiatric illness can improve patient outcome Effective treatment for psychiatric illness can decrease HIV transmission

    7. Aspects to be considered: Neuropsychiatric complications Psychiatric manifestations Treatment considerations

    8. Neuropsychiatric Complications

    9. HIV is a neurotropic virus

    10. Neuropsychiatric complications CNS OIs (Non-viral) CNS OIs (Viral) Systemic/metabolic complications Substance-induced complications Medication side effects Neurocognitive disorders

    11. OIs of the CNS (Non-Viral) Cerebral Toxoplasmosis Cryptococcal Meningitis Tuberculous (TB) Meningitis Atypical TB (MAI) Infection Candida Infection Neurosyphillis

    12. OIs of the CNS (Viral) Cytomegalovirus (CMV) Herpes Simplex Virus Progressive Multifocal Leukoencephalopathy (PML) Varicella-Zoster Virus

    13. CNS Neoplasms Primary CNS Lymphoma Secondary CNS Lymphoma Kaposi’s Sarcoma

    14. Systemic/Metabolic Complications Hypoxemia Electrolyte Disturbance (Dehydration) Fever Septicemia Uremia Hepatic Encephalopathy Anemia

    15. Psychoactive Substance-Induced CNS Complications Alcohol Amphetamines Cannabis Cocaine Hallucinogens Inhalants Sedative-Hypnotics Opiates

    16. Medication Side Effects Steroids: mania or depression, paranoia Interferon: neurasthenia fatigue syndrome, depresion and hypomania Interleukin 2: depression, disorientation, confusion, coma Efavirenz: decreased concentration, vivid dreams, depression Pentamidine: anxiety

    17. HIV-Associated Neurocognitive Disorders Minor Cognitive motor disorder (MCMD) HIV-Associated Dementia (not ADC) Delirium

    18. HIV-Associated Minor Cognitive Motor Disorder Mild syndrome of motor and/or cognitive dysfunction Minimal impairment in functioning Significant marker for reduced survival

    19. HIV-Associated Dementia The most frequent single neurologic of AIDS

    20. HIV-Associated Dementia Abnormality in two or more cognitive domains causing functional impairment Impaired motor performance or decline in motivation or emotional control No clouding of consciousness (Delirium) No confounding etiology

    21. HIV-Associated Dementia (HAD) Most common presenting clinical symptoms: - memory impairment - gait difficulty - mental slowing - depressive symptoms (social withdrawal and lack of interest)

    22. HAD Late Manifestations Global cognitive dysfuntion Mutism Aphasia Amnestic features Frontal lobe dysfunction Weakness Spasticity Dyskinesias Ataxia Myoclonus Seizures Coma

    23. HIV-Associated Delirium Prevalence: 43% - 65% (AIDS) Most common psychiatric dx in hospitalized critically ill patients with AIDS Associated with increased medical morbidity and mortality

    24. Psychiatric manifestations

    25. HIV-Associated Psychiatric Complications Mood disorders Substance Abuse Anxiety disorders Adjustment disorders Psychotic disorders Pain syndromes Sleep disorders

    26. Major Depression is the most commonly observed psychiatric disorder among persons with HIV infection. Point prevalence of 8%-67% Can be higher in the medically ill

    27. Depression and HIV Risk Factors Prior history of depression Psychoactive substance use Unemployment Lack of social support Use of avoidance coping strategies Perceived HIV-related physical symptoms Multiple losses

    28. Depression and HIV Diagnosis Asymptomatic stage of illness Symptomatic HIV disease Physical indicators of mood disturbance

    29. Depression and HIV Differential Dx Take special consideration when low CD4 -HIV-neurocognitive disorders (MCMD & HAD) -CNS OIs and neoplasms

    30. Depression and HIV Differential Dx Substance use Medication effects Endocrine abnormalities (hypogonadism, adrenals, thyroid) Nutritional (B-12 deficiency)

    31. Depression and HIV Treatment Optimal management includes psychological and psychopharmacological interventions Pharmacotherapy is mainstay—all antidepressants are equally effective

    32. Depression and HIV Treatment - Psychological Cognitive-behavioral therapy Interpersonal therapy Behavioral therapy Brief psychotherapy Short-term dynamic psychotherapy Supportive psychotherapy Group psychotherapy

    33. Depression and HIV Treatment – Psychological benefits Decrease high risk behaviors Increase compliance Enhance quality of life Improve coping Decrease utilization of health care services Lengthen survival time (?)

    34. Depression and HIV Treatment - Psychopharmacology Start with lower dose Titrate slowly Lower maintenance Drug-drug interactions Side effect profiles

    35. Depression and HIV Treatment - Psychopharmacology TCAs SSRIs SNRIs (Venl, Nefaz) Atypicals (Bup, Mirt) MAOIs Psychostimulants ECT Vagal Nerve Stimulation TMS

    36. Depression and HIV Treatment - Duration First episode: 6 – 9 months beyond resolution of symptoms Three or more episodes: consider tx for life

    37. Depression and HIV Suicide Completed suicide: 17 – 37-fold increase (1985-1987) Ideation: at serologic testing, at pivotal disease points and in HIV+ without AIDS

    38. Depression and HIV Suicidality – Risk Factors Prior attempt African American, Hispanic men Ages 25 – 54 Family Hx of suicidal attempts Psychiatric Hx Drug/Alcohol abuse or dependence Higher levels of distress, hopelessness

    39. Depression and HIV Suicidality - continued More reported HIV symptoms Multiple losses Unsettled sexual identity Poorly controlled pain Psychosocial stressors Stage of HIV disease Cognitive dysfunction

    40. HAART and Neurocognitive Disorders Protease inhibitors have poor blood-brain barrier penetration CNS reservoir Progression of neuropsychiatric complications with reduced peripheral viral load??

More Related