NEUROPSYCHIATRIC ASPECT OF HIV INFECTION AND AIDS

HIV AND ITS TRANSMISSION

HIV is present in blood, semen, cervical and vaginal secretions, and, to a lesser extent, in
saliva, tears, breast milk, and the cerebrospinal fluid of those who are infected.
HIV is most often transmitted through sexual intercourse or the transfer of contaminated blood
from one person to another.

Health providers should be aware of the guidelines for safe sexual practices and should advise
their patients to practice safe sex

 The probability of transmission, however,

could be higher, tergantung :
o Viral load of the contact person
o Oother factors, such as sexually transmitted diseases.The presence of sexually transmitted
diseases, such as herpes or syphilis, or other lesions that compromise the integrity of skin or
mucosa, further increases the risk of transmission.
 After infection with HIV, AIDS is estimated to develop in 8 to 11 years (MAKIN EARLY TREATMENT
 PROGRESS MAKIN LAMA)

DIAGNOSIS AND RELATED ISSUE

1. Serum Testing
 ADANYA HIV ANTIBODY  INDICATE INFECTION… NOT IMMUNITY TO INFECTION.
  HIV (-) TEST  Either not been exposed by HIV and are not infected or were exposed to HIV
tapi belum terbentuk antibody.
 Seroconversion (apaan tuh??? Seroconversion  change dari HIV (-) antibody test jadi HIV (+)
antibody test) most commonly occurs 6 to 12 weeks after infection, although in rare cases
seroconversion can take 6 to 12 months.
2. Counseling
 Apa aja indikasi untuk HIV testing?  look table !!
 Tapi, person who wants to be tested should probably be tested. The reasons for requesting a
test should be ascertained to detect unspoken concerns and motivations that may merit
psychotherapeutic intervention.
 Apa aja yang dilakukan saat pretest dan posttest?  look table !!!
3. Confidentiality
 The results of an HIV test can be shared with other members of a medical team, although the
information should be provided to no one else except in the special circumstances.
 The patient should be advised against disclosing the results of HIV testing too readily to
employers, friends, and family members; the information could result in discrimination in
employment, housing, and insurance.
 If, however, a treating physician knows that a patient who is HIV infected is putting another
person at risk of becoming infected, the physician may try either to hospitalize the infected
person involuntarily (to prevent danger to others) or to notify the potential victim.

CLINICAL FEATURE
1. Non neurological Factor
 About 30 percent of persons infected with HIV experience a flulike syndrome 3 to 6 weeks
after becoming infected; most never notice any symptoms immediately or shortly after their
infection.
 Flu-like syndrome kayak gimana? fever, myalgia, headaches, fatigue, gastrointestinal
symptoms, and sometimes a rash. The syndrome may be accompanied by splenomegaly and
lymphadenopathy.
 Apa aja penyakit yang bisa disebabkan oleh AIDS?  look table!!!
2. Neurological Factor
 Symptoms such as photophobia, headache, stiff neck, motor weakness, sensory loss, and
changes in level of consciousness should alert a mental health worker that the patient should
be examined for possible development of a CNS opportunistic infection or a CNS neoplasm.
 HIV infection can also result in a variety of peripheral neuropathies that should prompt mental
health clinicians to reconsider the extent of CNS involvement.
3. Psychiatric Syndrome
a. HIV-associated dementia
b. Delirium
c. Anxiety disorder
d. Depressive disorder
 A range of 4 to 40 percent of those infected with HIV have been reported to meet the
diagnostic criteria for depressive disorders.
 Depression is higher in women than in men.
e. Adjustment disorder
f. Mania
 Mood disorder with manic features, with or without hallucinations, delusions, or a disorder
of thought process, can complicate any stage of HIV infection, but most commonly occurs
in late-stage disease complicated by neurocognitive impairment.
g. Substance abuse
 Patient tempted to use substance regularly to deal with depression or anxiety.
h. Suicide
 The risk factors for suicide among persons infected with HIV are having friends who died
from AIDS, recent notification of HIV seropositivity, relapses, difficult social issues relating
to homosexuality, inadequate social and financial support, and the presence of dementia
or delirium.
i. Psychotic disorder
 Psychotic symptoms are usually later stage complications of HIV infection  need
antipsychotic.
j. Worried well
 Patient are seronegative and disease free TAPI anxious about contracting the virus.
 Some are reassured by repeated negative serum test results.
 Their worried well status can progress quickly to generalized anxiety disorder, panic
attacks, obsessive- compulsive disorder, and hypochondriasis.
TREATMENT
1. Prevention
 SAFE SEX PRACTICE
 AVOID SHARING CONTAMINATED HYPODERMIC NEEDLE
 The assessment of patients infected with HIV should include a complete sexual and substance-
abuse history, a psychiatric history, and an evaluation of the support systems available to
them.
2. Pharmacotherapy
 Give anti retroviral agent  apa aja?  look table!!!
 HATI-HATI INTERAKSI OBAT ANTIRETROVIRAL DAN OBAT PSIKOTROPIK
 Protease inhibitor  inhibit metabolisme antidepressant dan antipsikotik dan juga
benzodiazepine. Example : ritonavir inhibit metabolisme SSRI dan TCA. Alprazolam,
triazolam bisa meningkat konsentrasinya  hati-hati efek sedative.
 In turn, protease inhibitor may induce metabolisme valproate dan lorazepam  lower
concentration.
 Beberapa psikotropik (carbamazepine dan Phenobarbital)  reduce concentration of
protease inhibitor.
3. Psychotherapy
a. Approache (PeDeKaTe)
 Major psychodynamic themes for patients infected with HIV involve self-blame, self-
esteem, and issues regarding death. Some patients with HIV and AIDS feel that they are
being punished.
 Saat di test (+)  HIV-infected person akan bertanya mengenai disclosing his/her
serostatus. Most counselor suggest that patient bisa withhold disclosure to other until they
feel well-enough informed about HIV and its treatment and are ready to answer question
(safety?, stage of disease?, life span?)
 The psychiatrist can help patients deal with feelings of guilt regarding behaviors that
contributed to infection or AIDS.
 HIV-infected person must asses tidak hanya his/her readiness tapi juga kesiapan of
others to hear the announcement of seropositivity.
 INGAT!! Psychiatrist may be the only “safe” person to whom patient can express
discouragement, weariness, fear of treatment failure and fury or guilt.
b. Involve Other!!!
 The patient's family, lover, and close friends are often important allies in treatment.
 The patient's spouse or lover may have guilt feelings about possibly having infected the
patient or may experience anger at the patient for possibly infecting him or her.
 The involvement of members of the patient's support group can help the therapist assess
the patient's cognitive function and can also aid in planning financial and living
arrangements for the patient.
 Helping patient to cope with the illness and the prevent loss of a friend or family member.

Reference: Kaplan Sadock’s Synopsis of Psychiatry.

GOOD LUCK FOR MDE HIS … (^O^)v