HIV RELATED PSYCHOSIS

HIV/AIDS is known to have a direct effect on the central nervous system.
This presentation responds to the Question, "why is HIV/AIDS of importance in mental Health?"

1. HIV/AIDS RELATED PSYCHOSIS

2. OBJECTIVES Define HIV/AIDS and Psychosis List some psychiatric conditions related to HIV/AIDS infection Discuss the direct and indirect effect of HIV/AIDS on mental health. Discuss the importance of HIV/AIDS in mental Discuss the management of patients with HIV/AIDS induced psychosis

3. Introduction A psychotic disorder is one which is major in nature. This means the mental illness is one in which a patient experiences delusions and hallucinations. Furthermore, the patient is out of touch with reality.

4. Introduction cont ’ Due to the misperceptions (delusions and hallucinations) he/she experiences they imagine themselves to be somebody else in another world, place or situation of life. Psychotic symptoms can be found in schizophrenia, mania, depression and bi-polar affective disorders.

5. Prevelence There is a strong link between mental illness and HIV/AIDS; 50% or more of patients with HIV/AIDS have a comorbid psychiatric disorder. The prevalence of mental illness in patients with HIV/AIDS is reported to be 8 times higher than in those without HIV/AIDS. Depression, bipolar disorder, anxiety disorders, delirium, substance abuse, and schizophrenia have all been identified in persons receiving highly active anti­retroviral therapy (HAART).

6. Definitions HIV ( human immunodeficiency virus ) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. AIDS ( acquired immunodeficiency syndrome ). Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV)

7. Psychosis is a symptom, not an illness. A mental or physical illness, substance abuse, or extreme  stress  or trauma can cause it. It is defined as a condition that affects the way the brain processes information. It causes one to lose touch with reality. You might see, hear, or believe things that aren’t real

8. Effect of HIV/AIDS on Mental Health Emotional distress Emotional distress is common in people with HIV/AIDS for the following reasons: The nature of the AIDS physical symptoms Their progressive course The reactions of other people Some people at high risk for HIV (for example, Drug abusers) have other psychological problems

9. Psychiatric problems, such as: Adjustment disorders, Depressive disorders Anxiety disorders, Suicide and deliberate self harm Neuropsychiatric disorders Social consequences Problems in relation to illicit drug use Ethical problems

10. Psychiatric problems may occur to people with: Long standing social difficulties Lack of social support Previous psychological problems

11. Neurophysiological Disorders These are common due to immune suppression and the direct effects of HIV on the brain. This results into: Minor cognitive disorders common HIV associated dementia (AIDS-dementia complex) is the most common and goes undiagnosed. Patients given ARVs because it is AIDS defining condition. Because it mostly occurs with a CD4 less than 200.

12. HIV encephalopathy – It is caused by the HIV ‘virus’ itself. The virus attaches itself to the neurons in the brain which leads to the encephalitis. Managed with appropriate ARVs. In most cases these patients are taken to psychiatrists because of these symptoms. Hence appropriate diagnosis must be made to rule out HIV.

13. Sub acute encephalitis occurs in 1/3 of patients. Late in the illness Delirium may occur when there is an opportunistic infection or cerebral malignancy Psychosis is present in most of the above neuropsychological disorders. This may include psychiatric symptoms such as visual hallucinations, delusions.

14. There is a complex but significant interaction between mental health and HIV/AIDS. HIV affects mental health by its direct neurobiological action, the impact of having the illness, by its treatment including that for opportunistic infections and by its impact on the family

15. Effect of Mental illness on HIV/AIDS Patients with HIV/AIDS and psychiatric illness have a decreased quality of life, poor adherence to medications, faster disease progression, and increased mortality. In some cases individuals with psychiatric needs (victims of abuse, LD persons) may be more vulnerable to becoming infected with the virus.

16. Factors contributing to Psychosis in HIV/AIDS. Factors contributing to Psychosis in HIV infection rather than the direct effect og HIV virus on the brain include; Opportunistic infections, CNS neoplasm, Medications, Substance use disorder and other psychological stresses (McDaniel et al., 2000).

17. DIFFICULTIES IN CARE Care of these individuals is complicated by; The stigma of HIV/AIDS and The prevalence of the illness in underserved populations, as well as The need for complex medication regimens and The possibility of drug–drug interactions (DDIs).

18. MANAGEMENT A holistic approach is encouraged Socially Spiritually Physically Psychologically Note: you have to consider the complete person

19. MANAGEMENT Some of the factors to consider: Drug interaction btn ARVs and antipsychotics ARVs’ psychotic side effects Poor drug adherence by patient due to possible paranoia regarding medication.

20. Medication side-effects and drug–drug interactions are important considerations when patients are prescribed antipsychotic agents for the treatment of new-onset psychosis while concomitantly receiving HAART. For example, the enzymatic inhibition seen with protease inhibitors may lead to increased serum levels of antipsychotic agents and a greater potential for side-effects

21. Similarly, the ability of protease inhibitors and some atypical antipsychotic agents to cause weight gain and dyslipidaemia may lead to negative long-term outcomes such as diabetes, hypercholesterolemia, and cardiovascular events.

22. The ability of some antiretroviral agents (for example, zidovudine, efavirenz) to cause CNS effects (for example, nightmares, hallucinations) may also complicate the treatment of psychiatric disorders. Caution should thus be exercised when deciding on the pharmacological treatment of psychosis in HIV-infected individuals, ( Nebhinani and Mattoo , 2013).

23. As patients with HIV-associated psychosis are more sensitive to extrapyramidal side effects, so they require lower doses than other patients with psychosis. The use of atypical antipsychotics in the treatment of new-onset psychosis in HIV positive persons has proven helpful in reducing cases of extrapyramidal symptoms.

24. For example the use of risperidone (1mg-3.3 mg), Olanzapine (10 mg) and Clozapine (mean 27 mg) given in smaller dosages minimize extrapyramidal symptoms.

25. These antipsychotics fall in the Atypical(new generation antipsychotics) while the old generation antipsychotics also called Typical antipsychotics follow the same trend of smaller dosages( that is, chlorpromazine, haloperidol, trifluoperazine, thioridazine and fluphenazine depot).

26. Thus, since patients with HIV-associated psychosis are more sensitive to extrapyramidal side effects, consequently they need lower doses of antipsychotic drugs than other patients’ with psychosis.

27. Evaluation : The clinical evaluation of HIV-AIDS patients with psychotic symptoms requires broad history taking and physical examination, to rule out other known causes of psychosis. A careful history should include information about the onset and course of the patient’s symptoms. Signs of medical illness, drug intoxication, or medication toxicity should be considered during the examination ( Nebhinani and Mattoo , 2013).

28. Nursing Care Nursing aims To prevent injury To alley anxiety To prevent drug interaction and there complications To help client reach there maximum level of functioning independently.

29. Nursing Care If the patient is admitted to your ward or hospital. You may focus your nursing care on the following factors; Environment of the patient Psychological care Nutritional status Observations Medication Family therapy

30. Question? Why is HIV/AIDS of importance in mental health? [30 marks]

31. THE END