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Neuropsychiatric Disorders > HIV > Flashcards

HIV Flashcards

1
Q

What demographics are at highest risk for HIV?

A

White British homosexuals and African female heterosexuals

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2
Q

What are the initial signs of HIV infection?

A

Asymptomatic or minor cold symptoms

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3
Q

What conditions are associated with direct invasion of the brain by HIV?

A

▪️HIV encephalopathy
▪️AIDS dementia complex

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4
Q

When do neuropsychiatric symptoms usually occur in HIV?

A

In later stages when profound immunosuppression have occurred

(very low CD4)

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5
Q

What other causes of neuropsychiatric symptoms could be considered in someone with HIV?

A

Coincident active opportunistic infections (e.g. toxoplasmosis)

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6
Q

What is CD4?

A

A type of white blood cell used as a marker of immune function

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7
Q

What is normal CD4?

A

> 1,000

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8
Q

How does CD4 change across HIV infection?

A

Drops initially to fight it then bounces back up as you become a carrier. It then gradually decreases again as it wears down your immune system.

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9
Q

What happens as your CD4 gets lower?

A

You become immunocompromised and are more susceptible to other infections and the entry of these into the brain.

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10
Q

If CD4 becomes very low (~100), how much can CD4 be improved with treatment?

A

Normally only to around 500

(immune system is still 50% down)

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11
Q

What are some of the early neuropsychiatric symptoms of HIV infection?

A

▪️Memory difficulties
▪️Concentration difficulties
▪️Apathy
▪️Mood disturbance
▪️General mental slowing preceding specific deficits

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12
Q

What behavioural changes may be apparent with HIV infection?

A

▪️Apathy
▪️Social withdrawal
▪️Agitation
▪️Anxiety
▪️Irritability
▪️Emotional lability

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13
Q

What acute signs may indicate active HIV infection in the brain?

A

▪️Organic psychosis-like features (hallucinations, delusions)
▪️Motor dysfunction (poor balance, weakness, worse handwriting)

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14
Q

Without treatment, how quickly do neuropsychiatric symptoms deteriorate into a severe state?

A

Usually within months but may be longer

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15
Q

What condition may occur at extremely low levels of immunity in HIV?

A

Progressive multifocal leukoencephalopathy

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16
Q

What is progressive multifocal leukoencephalopathy?

A

A disease of the CNS resulting in destruction of the myelin sheath and diffuse white matter damage

17
Q

How might PML present on a CT scan?

A

Low density lesions with ‘scalloped’ edges

18
Q

What are the symptoms of PML?

A

▪️Rapidly progressive dementia
▪️Motor difficulties such as paresis, ataxia, and dysphagia

19
Q

What is the prognosis of PML?

A

Usually very poor but improving. Some people can make a full recovery

20
Q

Is there a relationship between cognitive performance and immunity in asymptomatic HIV positive subjects?

A

No

21
Q

What type of dementia is HIV dementia most similar to?

A

Parkinson’s dementia

22
Q

Is there a relationship between HIV and other psychiatric diagnoses?

A

No, although depressive symptoms in those with HIV may show improvement associated with improvement in physical HIV symptoms

23
Q

Which other populations have shown increased rates of HIV infection compared to the general population?

A

▪️Psychiatric inpatients
▪️Homeless people
▪️Individuals with schizophrenia

24
Q

What neuropsychiatric side effect has been associated with interferon for treatment of Hepatitis C?

A

Depression

25
Q

What are the main types of HIV medication?

A

▪️Nucleoside reverse transciptase inhibitors
▪️Non-nucleoside reverse transciptase inhibitors
▪️Protease inhibitors

26
Q

What side effects have been associated with nucleoside reverse transciptase inhibitors?

A

Abnormal dreams and depression

27
Q

What side effects have been associated with non-nucleoside reverse transciptase inhibitors?

A

Abnormal dreams, sleep disturbance, fatigue, depression, psychosis, suicidal ideation

28
Q

What side effects have been associated with protease inhibitors?

A

Sleep disturbance, drowsiness, fatigue, anxiety

29
Q

What is the main difference between the three types of HIV medication?

A

They target different points in the progression of HIV

30
Q

What class of drugs show interactions with HIV medication?

A

Psychotropics, particularly benzodiazepines and some antipsychotics

31
Q

What side effect may be seen with the interaction of HIV medication and benzodiazepines?

A

Excessive sedation

32
Q

What type of antidepressant is most likely to interact with HIV medication?

A

Tricyclic

33
Q

Which antipsychotic has a high incidence of adverse effects in HIV?

A

Chlorpromazine

34
Q

How do psychotropics typically interact with HIV medication?

A

via cytochrome P450 enzymes

35
Q

What type of antipsychotic is preferred for someone with HIV?

A

Atypical antipsychotics (e.g. Olanzapine, risperidone) at lower than normal doses

36
Q

What HIV medication side effects may be exacerbated by antipsychotics?

A

▪️Lipodystrophy
▪️Impaired glucose metabolism

37
Q

Is poorly controlled HIV associated with greater fatigue?

A

No!

Fatigue levels are more associated with psychological factors

Neuropsychiatric Disorders (30 decks)

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