0
1

There is a strong association between psychosis and HIV-related mood disorders (61). A retrospective review of the charts of 15 patients infected with HIV and receiving antiretroviral therapy suggested that the mood stabilizer divalproex sodium is well tolerated and does not increase viral load (62). In fact, new studies suggest that valproic acid might over time help to eradicate HIV from latent cells (63–65). Psychiatrists should closely monitor hepatic function and serum levels of valproic acid in the HIV patient, given the number of hepatically metabolized medications most patients with HIV have to take.

A study of 46 patients with HIV syndrome and mental illness showed that bipolar disorder was associated with nonadherence to antiretroviral therapy (66). A study of 2,459 New Jersey Medicaid beneficiaries found that patients with schizophrenia were not significantly less persistent in their use of antiretroviral therapy than those without serious mental illness, but patients with severe affective disorders were less persistent (67).

Primary psychosis can occur in HIV-positive patients, as can secondary psychoses associated with infectious, systemic, and cerebral complications of HIV infection (68). Case reports of psychosis, with or without manic features, have been associated with the use of efavirenz and other antiretroviral regimens, corticosteroids, antivirals such as ganciclovir and interferon-, antimicrobials such as sulfadiazine and dapsone, and buspirone (69–72). One case of reversible coma associated with the use of ritonavir with risperidone has been reported (73). Concerns have grown about the metabolic complications associated with the use of second-generation (atypical) antipsychotics (see "Metabolic Syndrome and Lipodystrophy" below), although they remain better tolerated than first-generation antipsychotics in patients with HIV/AIDS (74).

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 4.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 11.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 26.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 20.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 23.  >
Psychiatric News
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation