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Depression and HIV Patient

Depression and HIV Patient. Dr K T Tricoridis, Wits Donald Gordon Medical Centre. Case Study. Mrs PS , 45 , married 3 school going children, at a clinic .

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Depression and HIV Patient

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  1. Depression and HIV Patient Dr K T Tricoridis, Wits Donald Gordon Medical Centre

  2. Case Study • Mrs PS , 45 , married 3 school going children, at a clinic . • Aware that she has “changed” – impatient and very irritable, very worried about everything (her family , her work). She has no energy, can’t get out of bed, can’t face the complaints at work. Body aches and has bad headaches. • Sleeping very poorly. Appetite very hungry craves sweets but can’t eat a thing weight loss. • Can’t face people friends, not good enough , bad mother • Feels all have abandoned her, even God because all bad things are “sent “to her. • Children don’t help. Husband ignores her and seems to have a wondering eye(is always late from work). • Went to clinic to check why she has headaches and palpitations • Even more anxious as bloated . • Physical and bloods were taken.--------What bloods? • Asked to come in for results-------

  3. Depression • Depression describes many things like- short dip in ones mood, various degrees of sadness and a disorder . • Disorder- Specific AFFECTIVE and SOMATIC symptoms, lasting for at least 2 weeks; causing significant distress and impairment in social, occupational functioning.

  4. Symptoms • Affective- morbid preoccupation with worthlessness, constant guilt , mood is down, no interest in anything, anxiety , suicidal ideation. • Somatic- weight issues, appetite, sleep problems, agitation or retardation, tiredness and poor concentration, loss of libido.

  5. People at Risk: • Genetic predisposition, other medical conditions(infection, hepatitis, vits deficiencies) malnutrition, social problems • Past psychiatric history of depression, suicide attempts, anxiety, postpartum, mood disorders Substance abuse history • HIV scenario- Not disclosed one’s status, have lost loved ones to HIV, treatment failures, HIV MEDICATION IMPORTANT : to screen for depression- improves the HIV treatment outcome

  6. Lifetime Prevalence of Depression tends to be higher in patients with HIV • The range tends to be 22-60 %. • Illness progression does not seem to increase the rate of depression

  7. Treatments • Antidepressants • SSRI- Fluoxetine, Citalopram, Sertraline • Buproprion • Venlefaxine • Trazodone • Tricyclics

  8. Hormones • ECT • PSYCHOTHERAPY - CBT - -Adjustment disorders • OTHER –mood stabiliser –Epilim, Lamotrigine Length treatment -8-12 months Side effects START SLOW and GO SLOW and COME OFF EVEN SLOWER

  9. CAREFUL • Drug –drug interaction • Protease Inhibitors (Norvir(ritonavir) or Kaletra (lopinavir + ritonavir),. Ritonavir may increases the amount Wellbutrin and Serzone and St John’s wort • Individual Sensitivity and Side effects

  10. SUICIDE • SUICIDE RISK– • Previous history • Family History • Ideation –Planning or fantasy • Males and Females • Degree of hopelessness, support structures • Religion

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