Presentation on theme: "Depression and HIV Patient"— Presentation transcript:
1Depression and HIV Patient Dr K T Tricoridis,Wits Donald GordonMedical Centre
2Case StudyMrs 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 motherFeels 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 palpitationsEven more anxious as bloated .Physical and bloods were taken What bloods?Asked to come in for results
3DepressionDepression 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.
4SymptomsAffective- 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.
15People at Risk:Genetic predisposition, other medical conditions(infection, hepatitis, vits deficiencies) malnutrition, social problemsPast psychiatric history of depression, suicide attempts, anxiety, postpartum, mood disorders Substance abuse historyHIV scenario- Not disclosed one’s status, have lost loved ones to HIV, treatment failures, HIV MEDICATIONIMPORTANT : to screen for depression- improves the HIV treatment outcome
19HormonesECTPSYCHOTHERAPY- CBT --Adjustment disordersOTHER –mood stabiliser –Epilim, LamotrigineLength treatment monthsSide effectsSTART SLOW and GO SLOW and COME OFF EVEN SLOWER
20CAREFUL Drug –drug interaction Protease Inhibitors (Norvir (ritonavir) or Kaletra (lopinavir + ritonavir),. Ritonavir may increases the amount Wellbutrin and Serzone and St John’s wortIndividual Sensitivity and Side effects
21SUICIDE SUICIDE RISK– Previous history Family History Ideation –Planning or fantasyMales and FemalesDegree of hopelessness, support structuresReligion