Mental health disorders are common in some HIV infected people. In some instances, mental disorders are existing prior to the HIV infection (which increases the risk of infection), while in other instances, HIV could result in mental health disorders as a psychological consequence of the infection or because of the presence of the HIV virus on the brain.
There is strong evidence of the relationship between substance use disorders and mental illness with HIV infection.
It is important to be aware that HIV individuals have an increased risk of developing mood, conduct, and cognitive disorders.
Therefore, there are two groups of people who develop mental health disorders and HIV infection.
- Those with pre-existing mental illnesses who become secondarily infected with HIV infection
- Those who are HIV positive and present with mental health disorders (either directly or indirectly)
The groups of common mental health disorders among people living with HIV include organic and mood disorders. People living with HIV are also prone to alcohol, and other substance use disorder, psychotic disorders, and social difficulties faced as a result of stigma and discrimination or exacerbation of pre-existing mental disorders, including depression, mania anxiety disorders, and substance use may be related to the stress of living with HIV and AIDS.
Other mental disorders may be secondary to neurological complications of HIV, opportunistic infections, or side effects of ARV drugs. They include delirium with or without focal neurological signs or with signs of HIV associated dementia.
Pre-existing mental disorders are associated with an increased risk of acquiring HIV infection and substance use disorders. This group of patients often comes to Antiretroviral Therapy (ART) services with special management needs, including drug interactions.
Delirium is a state of acute onset altered consciousness marked by anxiety, incoherent or disorganized speech, disorientation, and hallucinations.
The distinguishing features, include drowsiness, lethargy, and a changing level of alertness. The person has difficulties with attention, focus, and judgement, and there may be perceptual disturbance such as seeing or hearing things that are not there(hallucinations).
All these symptoms usually develop over hours or days, and the presentation fluctuates.
Importance: Delirium is a medical emergency and may be life-threatening; hence requires immediate medical attention.
It often occurs in patients with severe medical illness, pre-existing dementia, substance use intoxication/withdrawal, and acute head injury. Delayed diagnosis and management of delirium can be fatal.
When assessing children and adolescents, family members can be very helpful in alerting the clinical staff to the unusual nature of their child’s behaviors.
Risk Factors: Risk factors for developing delirium include:
- Advanced stages of immune suppression
- Substance use/intoxication
- Head/brain injuries
- Previous episodes of delirium
- HIV-associated dementia or infections and malignancies of the Central Nervous System
- Drug interactions in AIDS patients taking multiple medications
- Drug overdose (accidental or deliberate)
- High fever from any cause
- Intoxication from any cause
Among children and adolescents, delirium caused by medications or substance use may be more common, especially when there is a lack of pediatrics formulations of medications.
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