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Mental Illness & Psychiatric disorders


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HIV Infection & Psych Disorderes
mental disorders can increase risk of disorders

neuropathology of virus

opportunistic infection

psychiatric disorders decrease adherence to antiretroviral meds
Major Depression and HIV Infection
can occur in up to 40%

peak around time tested and time AIDS develops

Watch that normal fatigue due to the disease is not misdiagnosed
AZT, acylovir, and interferion INH and sulfonamides can cause what?
depression & delirium
chronic pain in HIV can contribute to depression T/F
Interactions can happen with Antidepressants and HIV medications. T/F
If pts have neuro symptoms shoudl also check for _______ & _________
syphilis & cryptococcal disease
results of HIV-I invading CNS
HIV associated minor cognitive disorder and HIV associated dementia
HIV Associated Minor Cognitive Disorder
associated minor cognitive disorder may occur in patients who are otherwise asymptomatic or mildly symptomatic. The disorder is characterized by subcortical deficits of attention, information processing speed, learning and memory, and psychomotor skills. HIV associated minor cognitive disorder may be complicated by the presence of depression or anxiety, but is not caused by psychiatric problems.
HIV Associated Dementia (HAD)

When does it happen?

What is indicated?
progressive disorder

apathy, inertia, cognitive slowing, memory loss, and social withdrawal
As it progresses, multiple cognitive functions become increasingly impaired
The terminal phases are characterized by global cognitive impairment, mutism, and severe psychomotor retardation

usually happens after AIDS develops

Neuropsychological eval recommended
Treatment for HAD
Treatment with azidothymidine (Retrovir, AZT, DZV) has been associated with improvement in cognitive functioning
acute psychotic disorders
magnetic resonance image of the brain and examination of cerebral spinal fluid should be carried out as soon as possible.
acute psychotic disorder, regardless of the etiology,
the use of a conventional antipsychotic agent, e.g. haloperidol 5 mg PO or IM, is usually successful
In less acute symptomatic psychotic disorders and in primary comorbid psychosis
the use of atypical antipsychotic agents is again the treatment of choice
Clozapine contraindicated because
well-tolerated with few drug interactions and positive studies in HIV+
contraindicated in combilation with ketoconazole, ritonavir, and macralide antibiotics
Cerebrovascular Accident (Stroke)
They often suffer sudden, multiple loss events

They may lose the neurological capacity to process these loss events

Stroke may affect areas of the brain directly involved in control of mood.
peak MDD between 6 mo. to 2 years post stroke

pt prevolence 10-34%

more often younger and white

less likely to be alive 3 yrds post stroke
at risk locations
Left frontal pole
clue to depression in stroke
deterioration after improvement
pathological emotionalism present in ______ stroke victems
treatment w/ SSRIs
early prophylactic, keep them on treatment for longer than normal
MDD what percentage?

biphasic- early in onset and late in onset.

MDD can predate motor symptoms by 6 yrears
what percent have depression?
younger pts more so than older
Differential Diagnosis of MS
adjustment disorders
paroxysmal changes in mood (such as pathological crying or emotional lability)
mood changes in relation to drugs for MS.
-anti-spasticity drugs (including baclofen, dantrolene, and tizanidine)
-discontinuation of baclofen and other anti-spasticity drugs
-interferon treatment is a risk factor for depression in MS
Suicide and MS
huge problem in MS

Risk factors include:
-young age of onset
-previous history of depression, social isolation, and substance abuse
-alcohol abuse.
Huntington’s Disease
Inherited disease of movement, cognition and emotion
Behavior changes and personality changes are core symptoms
Depression, irritability, or anxiety is often the first symptom
Myocardial Infarction
20% of patients hospitalized for MI are also suffering from Major Depression

Depression during initial hospitalization is related to poor quality of lif in the first year post-MI

Depression leads to a 3-fold increase in risk of death post-MI

Patients can be effectively treated

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