1. Is it a potential indicator to initiate HAART?
“AIDS Mania ”
Is it a potential indicator to initiate HAART?
decreased need for sleep
Early recognition and treatment of manic symptoms improve quality of life, protect from further cognitive deterioration and decrease mortality.
Mariana Marinho1, João Marques1,2, Miguel Bragança1,3
Clinic of Psychiatry and Mental Health of São João Hospital Centre, Porto, Portugal, 2. Clinic of Psychiatry of Local Healthcare Unit of Matosinhos, Matosinhos, Portugal
3. Department of Clinical Neurosciences and Mental Health of Faculty of Medicine, University of Porto, Porto, Portugal
INTRODUCTION AND OBJECTIVES
Mania occurs in higher rates among individuals with HIV/AIDS, especially with the progression of HIV infection, and constitutes an additional risk factor for facilitate the transmission of HIV.
Objectives: To provide an overview of of secondary mania in HIV-infected patients.
2. METHODS
Literature review based on articles published on PubMed/MEDLINE, between January 2000 and August 2015, using the keywords“HIV”, “AIDS” and “mania”.
3. RESULTS
HIV-related medications
Causes of AIDS mania
Substance abuse
CNS infection with HIV (MOST IMPORTANT)
Medical illness including opportunistic infections, systemic disorders, direct insult to the brain
AIDS mania
Manic-like disorder as a direct effect of the HIV infection
No prior symptoms
No prior history of Bipolar disorder or Major Depressive disorder
No family history
Onset after HIV disease
No delirium
Mostly female
Tends to occur in patients with more advanced immunosuppression
Tends to be associated with HIV-related cognitive impairments.
Higher rates than general population - may be as high as 4% in a clinic population
AIDS mania predispose to HIV risk behaviors and, thus, constitutes an additional risk factor for facilitate the HIV spread!
AIDS mania - differs from primary mania with regard to clinical presentation, course, management and prognosis
Clinical presentation
More irritable mood
More aggressive and disruptive
More talkative
More delusions
More auditory and visual hallucinations
Much more likely cognitive deficits
Psychomotor slowing
Increased severity
Otherwise has DSM-5 manic-like symptoms
More resistant to tratment
Respond faster to antipsychotics ??
More chronic than episodic course
Early recognition and treatment of manic symptoms:
- Improve quality of life
- Protect from further cognitive deterioration
- Decrease mortality
Management
Course and Prognosis
Mood stabilizer and/or antipsychotic (>>atypical)
HAART may lead to viral replication reduction in the CNS
Special attention to medication toxicity, drug interactions and adherence
Psychotherapy in combination with drug tratment (in selected patients)
The occurrence of HIV mania may announcer the transition from HIV infection to AIDS perhaps before other clinical signs are evident!
4. CONCLUSION
Mania has been associated with HIV/AIDS and in many instances acts as a barrier to achieving best treatment outcomes. Thus, psychiatrists need to be aware of the complexities involved in the emergence of manic episodes in HIV-infected patients in order to deal with them in the most appropriate and effective manner.
5. BIBLIOGRAPHY