Kk&s Ch.11 Neuropsych Of Hiv And Aids

Front 1

What is HIV? What does it do to body?

Back 1

Retrovirus that targets certain immune system cells -- the CD4+ Helper T cells that are responsible for coordinating attacks against infection.
This virus gets right into those cells DNA and turns it into a factory for making more viruses.
It's hard to get at because it mutates and lives inside human cells.
At first, most people have no sx but within about 10 years, most people suffer from a major immune defiency or AIDS where immune system gets weaker and weaker.

Front 2

What might be early sx?

Back 2

enlarged lymph nodes
persistent flu like sx: night sweats, mailase, fevers

Front 3

When do you get infections?

Back 3

When CD4+ count gets to < 200 well below normal of 1000

Front 4

What are the infections you might see?

Back 4

PCP
Kaposi's Sarcoma
TB
Fungal Infections

Front 5

How is HIV transmitted?

Back 5

Blood, Sex

Front 6

Chances of infection after single exposure?

Back 6

3/100 Anal (recipient) sex 0.8-3%
7/1000 IVDU with contaminated needle 0.67%
3/1000 Accidental contaminated needle stick 0.3%
2/1000 Vaginal sex 0.15%

Front 7

“How do we test for it?”, meaning of positive test? meaning of negative test

Back 7

Serum Test- Anti-HIV antibodies
The test is 99.9% sensitive and specific for HIV infection
Negative test two possibilities
True Negative (don't have virus)
Not yet Positive because seroconversion happens as late as 4 months after infection)

Front 8

What is pre-test counselling of HIV?

Back 8

Document in chart:
Review reasons for testing
Review meaning of +/- Test
Review expected reaction
Review plans if positive: inform, reportable disease

Front 9

Post-test counselling?

Back 9

If negative, review risk reduction
If positive:
Inform
Refer for tx of aids and support
Review reducing transmission

Front 10

“What happens if the patient refuses to tell their partner about the HIV infection?”

Back 10

Oligated to inform victim, police

Front 11

“Are there any psychiatric illnesses associated with HIV/AIDS?”

Back 11

MACS
Mood: dep, mania
Anxiety, Adjustment Ds
Cog: Mild Neurocognitive disorder of HIV, dementia, delirium
Substance Abuse/Dependence

Front 12

“If this patient feels he would like to go into psychotherapy, what are some of the isssues we might anticipate in relation to HIV/AIDS?

Back 12

1. Shame; self-blame
2. Anger at Dx
3. Death and dying
4. Guilt ... potential infection
5. Fear of employer, friend disclosure
6. Tx side fx
7. Idealization of cure, minimization of risk
8. Change in sexual fxn

Front 13

HIV dementia: CSF cell counts?

Back 13

CSF cell counts are lower than they are in bacterial infections
true; CSF is usually acellular, but 25% have mononuclear pleocytosis

Front 14

HIV dementia ... is AIDS a requirement?

Back 14

NO

Front 15

HIV Dementia and seizure complication ... common early or rare?

Back 15

rare

Front 16

How are most HIV transmissions occuring?

Back 16

heterosexually

Front 17

Some studies have shown that about ? percent of the regular sex partners of persons with HIV infection become infected themselves, a statistic suggesting that some persons do not yet understand immunity or resistance to HIV infection

Back 17

50%

Front 18

The risk of infection of health care workers after a needlestick is rare, about 1 in ? incidents

Back 18

300

Front 19

Children can be infected in utero or through breast-feeding when their mothers are infected with HIV. Zidovudine (Retrovir) and protease inhibitors taken by the HIV-infected pregnant woman prevent perinatal transmission in ?

Back 19

more than 95 percent of case

Front 20

Seroconversion most commonly occurs ? weeks after infection, although in rare cases seroconversion can take ? months.

Back 20

6 to 12
6 to 12

Front 21

List 11 items in pre-test HIV counselling

Back 21

1. Discuss meaning of a positive result and clarify distortions (e.g., the test detects exposure to the AIDS virus; it is not a test for AIDS).
2. Discuss the meaning of a negative result (e.g., seroconversion requires time, recent high-risk behavior may require follow-up testing).
3. Be available to discuss the patient's fears and concerns (unrealistic fears may require appropriate psychological intervention).
4. Discuss why the test is necessary. (Not all patients will admit to high-risk behaviors.)
5. Explore the patient's potential reactions to a positive result (e.g. “I'll kill myself if I'm positive”). Take appropriate necessary steps to intervene in a potentially catastrophic reaction.
6. Explore past reactions to severe stresses.
7. Discuss the confidentiality issues relevant to the testing situation (e.g., is it an anonymous or nonanonymous setting?). Inform the patient of other possible testing options where the counseling and testing can be done completely anonymously (e.g., where the result is not made a permanent part of a hospital chart). Discuss who has access to the test results.
8. Discuss with the patient how being seropositive can potentially affect social status (e.g., health and life insurance coverage, employment, housing).
9. Explore high-risk behaviors and recommend risk-reducing interventions.
10. Document discussions in chart.
11. Allow the patient time to ask questions.

Front 22

HIV post-test counselling?

Back 22

# Interpretation of test result:
Clarify distortion (e.g., “a negative test still means you could contract the virus at a future time; it does not mean you are immune from AIDS”).
Ask questions about the patient's understanding and emotional reaction to the test result.
# Recommendations for prevention of transmission (careful discussion of high-risk behaviors and guidelines for prevention of transmission).
# Recommendations on the follow-up of sexual partners and needle contacts.
# If test result is positive, recommendations against donating blood, sperm, or organs and against sharing razors, toothbrushes, and anything else that may have blood on it.
# Referral for appropriate psychological support:

Front 23

The most common infection in persons infected with HIV who have AIDS is? , which is characterized by ?
How Dx?

Back 23

The most common infection in persons infected with HIV who have AIDS is Pneumocystis carinii pneumonia, which is characterized by a chronic, nonproductive cough, and dyspnea, sometimes sufficiently severe to result in hypoxemia and its resultant cognitive effects
Dx: by bronchoscopy and alveolar lavage
Tx: trimethoprim and sulfamethoxazole (Bactrim, Septra) or pentamidine isethionate (Pentam), which can also be used for prophylaxis against the pneumonia

Front 24

The other disease that was initially associated with the development of AIDS is ?, a previously rare, blue-purple-tinted skin lesion.

Back 24

Kaposi's sarcoma

Front 25

The development of HIV dementia is generally a poor prognostic sign, and ? percent of patients with dementia die within ? months.

Back 25

The development of dementia is generally a poor prognostic sign, and 50 to 75 percent of patients with dementia die within 6 months.

Front 26

HIV + It is characterized by impaired cognitive functioning and reduced mental activity that interferes with work, homemaking, or social functioning =?

Back 26

A less severe (than dementia ) form of brain involvement is called HIV-associated neurocognitive disorder, also known as HIV encephalopathy.

Front 27

What is the challenge in dx'ing depression in person with HIV?

Back 27

poor sleep and weight loss part of infection

Front 28

Can Mania occur in HIV?

Back 28

late stage possibly

Front 29

List risk factors for suicide in patient with HIV:

Back 29

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.

Front 30

he antiretroviral agents have many adverse effects. Of importance to psychiatrists is that

Back 30

protease inhibitors are metabolized by the hepatic cytochrome P450 oxidase system and, therefore, can increase levels of certain psychotropic drugs that are similarly metabolized

Front 31

Which drugs can have levels increased by protease inhibitors?

Back 31

These include bupropion (Wellbutrin),
meperidine (Demerol), various benzodiazepines, and
selective serotonin reuptake inhibitors (SSRIs).

Front 32

What are protease inhibitors?

Back 32

the VIR's
Ritonavir, Indinavir, Nelfinavir, Saquinavir

Front 33

Principle in HIV tx?

Back 33

treat anything treatable

Front 34

Major psychodynamic themes for patients infected with HIV involve

Back 34

self-blame,
self-esteem, and
issues regarding death.
The psychiatrist can help patients deal with feelings of guilt regarding behaviors that contributed to infection or AIDS. Some patients with HIV and AIDS feel that they are being punished. Difficult health care decisions, such as whether to
initiate or continue taking antiretroviral medication and terminal care and life-support systems, should be explored, and here denial of illness may be evident. Major practical themes involve employment, medical benefits, life insurance, career plans, dating and sex, and relationships with families and friends.