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Secondary Mania in HIV

Secondary Mania in HIV . Dr Chioni Siwo M.Med (Psych) 2nd year student University of Zambia 2012. GOOD MORNING. OUTLINE. What is it Secondary Mania (in HIV)? Prevalence Causes Clinical Picture Treatment Gaps in literature Proposed study. What is it?.

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Secondary Mania in HIV

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  1. Secondary Mania in HIV Dr ChioniSiwo M.Med (Psych) 2nd year student University of Zambia 2012

  2. GOOD MORNING

  3. OUTLINE • What is it Secondary Mania (in HIV)? • Prevalence • Causes • Clinical Picture • Treatment • Gaps in literature • Proposed study

  4. What is it? • Manic-like disorder occurring as a direct effect of the HIV infection • No delirium • No prior history of Bipolar disorder or Major Depressive disorder. • Otherwise has DSM-IV manic-like symptoms

  5. Prevalence • Not known globally • Not known in sub-Saharan Africa • Study by Owen Larsson et al in Australia showed a prevalence of 8% over 17 months • Most common cause of admission to psychiatric hospital in Uganda especially females

  6. Causes • Medication e.g. Isoniazid, anti-depressants, steroids • Direct Insult to the brain e.g. traumas, strokes, tumours • Systemic Disorders such as Hyperthyroidism, Hyperparathyroidism • Substance Abuse

  7. Clinical Picture Study by Ethel Mpungu et al in Uganda in 2006, found that HIV positive patients with Mania were: • found to have more manic symptoms (YMRS) • more irritable • more aggressive and disruptive

  8. Clinical Picture contd… • more talkative and had decreased need for sleep • had more delusions, auditory and visual hallucinations • mostly female

  9. Treatment • Studies have reported the use of Haloperidol and Diazepam in acute phase • It was found that HIV patients with secondary mania responded in 2 weeks or less than • Patients with Secondary mania in HIV respond faster to antipsychotic drugs than patients with Bipolar mania

  10. Gaps in the scientific literature • Do they benefit from continued anti-manic medication? • Do they have a complete recovery? In particular do they function behaviourally, socially, and occupationally?

  11. Proposed study • Case Series of 30 patients with secondary mania HIV followed up for 6 months • Focusing on clinical, biological and psychosocial measures • Results will be analyzed for patterns in the illness and this will help with future management of patients

  12. Objective • To gain greater knowledge of the secondary mania, its clinical and psychosocial correlates and its response to treatment. • To improve the management of patients by using evidence based management interventions including treatment of associated physical health conditions. • Also to get a better understanding of the burden of disease resulting from this mental disorder in HIV

  13. Methodology • SITE A case series of 30 patients will selected from Chainama Hospital (Zambia’s only psychiatric tertiary hospital) and University Teaching Hospital (HIV) clinic both in Lusaka • SETTING It will be a longitudinal study observing progress of the cases from commencement over a period of 6 months

  14. Methodology contd….. • Selected clinical observations will be made at 1, 3 and 6 months • Family will be included • Selection: patients will included upon meeting DSM-IV criteria A-D for manic episode

  15. Measures • Semi-structured Psychiatric interview of patient • Young’s mania rating scale • AUDIT a measure of alcohol intake • MMSE

  16. Measures contd… • Measure of behaviour in home circumstances – semi-structured interview • Semi-structured interview of informants e.g. relatives • For female patients menstrual cycle will be included

  17. Measures contd… • Physical examination • For female patients menstrual cycle will be included • CD4 • Sputum for AAFB, CXR • C-Reactive protein • FBC/ESR

  18. Measures contd… • LFT, Creatinine • RPR • Renal function • Nutritional status and BMI • MRI of brain – near first episode when any secondary mania neuropathology may be detectable

  19. Ethics • Approval will be sought from the University of Zambia Research and Ethics Committee • Informed consent will be sought from the participants • There may be issues of confidentiality in the follow up and the involvement of the relatives when a manic patient may not be able to give informed consent

  20. Limitations of the Study • There will be a bias in the case selected in that uncooperative patients and relatives will be excluded • No intervention will be evaluated, study will not lead directly to improvement of patient management. • No epidemiological conclusions can be drawn

  21. Acknowledgements • Dr Ravi Paul, HOD, Department of Psychiatry, School of Medicine, UNZA • Dr Gil Blackwood Honorary Lecturer, School of Medicine, Department of Psychiatry, UNZA

  22. References • E Nakimuli-Mpungu, S Musisi Clinical presentation of Bipolar mania in HIV positive patients in Uganda Psychosomatics 50:4 July-august 2009 • Nakimuli-Mpungu, S Musisi Early onset versus late onset HIV related secondary mania in Uganda Psychosomatics 49:530-534 2008 • E Nakimuli-Mpungu, S Musisi Primary mania versus HIV related secondary mania in Uganda American Journal of Psychiatry 163:8, August 2006 • Owen-Larsson HIV infection and Psychaitric illness African Journal of Psychiatry Volume 12, no.2 2009 • Charles Krauthammer, MD; Gerald L. Klerman Secondary mania Arch Gen Psychiatry 35(11):1333-1339, 1978

  23. THANK YOU!

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