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28 Cards in this Set
- Front
- Back
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HIV Infection & Psych Disorderes
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mental disorders can increase risk of disorders
neuropathology of virus opportunistic infection psychiatric disorders decrease adherence to antiretroviral meds |
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Major Depression and HIV Infection
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can occur in up to 40%
peak around time tested and time AIDS develops Watch that normal fatigue due to the disease is not misdiagnosed |
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AZT, acylovir, and interferion INH and sulfonamides can cause what?
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depression & delirium
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chronic pain in HIV can contribute to depression T/F
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T
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Interactions can happen with Antidepressants and HIV medications. T/F
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T
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If pts have neuro symptoms shoudl also check for _______ & _________
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syphilis & cryptococcal disease
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results of HIV-I invading CNS
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HIV associated minor cognitive disorder and HIV associated dementia
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HIV Associated Minor Cognitive Disorder
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associated minor cognitive disorder may occur in patients who are otherwise asymptomatic or mildly symptomatic. The disorder is characterized by subcortical deficits of attention, information processing speed, learning and memory, and psychomotor skills. HIV associated minor cognitive disorder may be complicated by the presence of depression or anxiety, but is not caused by psychiatric problems.
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HIV Associated Dementia (HAD)
When does it happen? What is indicated? |
progressive disorder
apathy, inertia, cognitive slowing, memory loss, and social withdrawal As it progresses, multiple cognitive functions become increasingly impaired The terminal phases are characterized by global cognitive impairment, mutism, and severe psychomotor retardation usually happens after AIDS develops Neuropsychological eval recommended |
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Treatment for HAD
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Treatment with azidothymidine (Retrovir, AZT, DZV) has been associated with improvement in cognitive functioning
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acute psychotic disorders
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magnetic resonance image of the brain and examination of cerebral spinal fluid should be carried out as soon as possible.
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acute psychotic disorder, regardless of the etiology,
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the use of a conventional antipsychotic agent, e.g. haloperidol 5 mg PO or IM, is usually successful
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In less acute symptomatic psychotic disorders and in primary comorbid psychosis
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the use of atypical antipsychotic agents is again the treatment of choice
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Clozapine contraindicated because
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agranulocytosis
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Zyprexa
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well-tolerated with few drug interactions and positive studies in HIV+
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Quetiapine
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contraindicated in combilation with ketoconazole, ritonavir, and macralide antibiotics
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Cerebrovascular Accident (Stroke)
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They often suffer sudden, multiple loss events
They may lose the neurological capacity to process these loss events Stroke may affect areas of the brain directly involved in control of mood. |
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Stroke
-Epidemiology- |
peak MDD between 6 mo. to 2 years post stroke
pt prevolence 10-34% more often younger and white less likely to be alive 3 yrds post stroke |
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at risk locations
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Pallidium
Left frontal pole |
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clue to depression in stroke
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deterioration after improvement
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pathological emotionalism present in ______ stroke victems
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20%
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treatment w/ SSRIs
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early prophylactic, keep them on treatment for longer than normal
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Parkensons
MDD what percentage? |
20-40%
biphasic- early in onset and late in onset. MDD can predate motor symptoms by 6 yrears |
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MS
what percent have depression? |
25-40%
younger pts more so than older |
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Differential Diagnosis of MS
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adjustment disorders
paroxysmal changes in mood (such as pathological crying or emotional lability) mood changes in relation to drugs for MS. -steroids -anti-spasticity drugs (including baclofen, dantrolene, and tizanidine) -discontinuation of baclofen and other anti-spasticity drugs -interferon treatment is a risk factor for depression in MS |
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Suicide and MS
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huge problem in MS
Risk factors include: -Male -young age of onset -previous history of depression, social isolation, and substance abuse -alcohol abuse. |
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Huntington’s Disease
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Inherited disease of movement, cognition and emotion
Behavior changes and personality changes are core symptoms Depression, irritability, or anxiety is often the first symptom |
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Myocardial Infarction
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20% of patients hospitalized for MI are also suffering from Major Depression
Depression during initial hospitalization is related to poor quality of lif in the first year post-MI Depression leads to a 3-fold increase in risk of death post-MI Patients can be effectively treated |
