Depression, mania, and schizophrenia in HIV-infected patients
- Andrew A Pieper, MD, PhD
Andrew A Pieper, MD, PhD
- Professor of Psychiatry
- Director of Division of Translational Neuroscience
- University of Iowa Carver College of Medicine
- Glenn J Treisman, MD, PhD
Glenn J Treisman, MD, PhD
- Professor of Psychiatry and Behavioral Sciences, Professor of Medicine
- Johns Hopkins University School of Medicine
Neuropsychiatric disorders are common in individuals infected with the human immunodeficiency virus (HIV), based upon a wide variety of factors that include direct effects of the virus preexisting psychiatric conditions, personality vulnerabilities, affective disorders, addictions, or responses to the social isolation and disenfranchisement that are frequently associated with the diagnosis of HIV. Adding to the complexity, many HIV-infected persons have difficulty with treatment adherence due to their behavior patterns as well as specific neuropsychiatric disorders associated with HIV disease progression .
However, more recent findings have demonstrated that identification and treatment of psychiatric disorders in AIDS patients increases their likelihood of being prescribed antiretroviral therapy (ART) . As an example, in a cohort of patients (n = 549) with AIDS at an HIV clinic offering onsite psychiatric services, patients receiving treatment for a psychiatric disorder were twice as likely to receive ART for at least six months compared to patients who were not diagnosed with a psychiatric disorder (adjusted odds ratio 2.1, 95% CI 1.2-3.7). Prescription of ART was also associated with a 40 percent reduction in mortality compared to patients without a psychiatric disorder .
HIV-associated depression, mania, and schizophrenia will be reviewed here. An overview of the range of neuropsychiatric conditions associated with HIV infection and more detailed reviews of other specific conditions are discussed separately. (See "Overview of the neuropsychiatric aspects of HIV infection and AIDS" and "HIV-associated neurocognitive disorders: Epidemiology, clinical manifestations, and diagnosis" and "Substance abuse and addiction in HIV-infected patients".)
Among patients with HIV, comorbid depression is common and is associated with nonadherence to HIV treatment . Prevalences for major depression (table 1) among patients with HIV and AIDS have been estimated to be between 15 and 40 percent, far exceeding that seen in the general population . Major depression increases the risk of acquiring HIV through intensification of substance abuse and exacerbation of self-destructive behaviors, such as exposure to an increased number of sexual partners and lack of condom use . Patients with major depression are also at increased risk for HIV disease progression and mortality .
HIV increases risk of developing depression through direct damage to subcortical brain areas, chronic stress, worsening social isolation, and intense demoralization. Since depression is underdiagnosed and under-treated in medical clinics it has become one of the most significant factors in the HIV/AIDS epidemic .
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- MAJOR DEPRESSION
- Clinical features
- - Pharmacologic
- Dose and side effects
- Drug interactions
- Augmentation strategy
- Changing drugs
- - Psychotherapeutic
- Clinical course of bipolar illness
- AIDS mania
- - Epidemiology
- - Clinical course
- - Bipolar illness
- - AIDS mania
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS