Psychopathology of first-episode psychosis in HIV-positive persons in comparison to first-episode schizophrenia: A neglected issue

Abstract

This study aims to detect different psychopathological dimensions in first-episode psychoses with different underlying causes. We evaluated 22 subjects with first-episode psychosis, who differed in biological variables (HIV-positive versus HIV-negative) and who were compared by using the Structured Clinical Interview for DSM-III-Reviewer, the 18-item Brief Psychiatric Rating Scale (BPRS), the 17-item Hamilton Depression Rating Scale, the 14-item Hamilton Anxiety Rating Scale and the Mini-Mental State Examination. HIV-positive subjects had higher mean scores on the global BPRS and on the paranoid Positive and Negative Syndrome Scale subscale compared with HIV-negative subjects. Conversely, higher prevalence of affective and anxious symptoms was found in the HIV-negative patients in comparison to HIV-positives. HIV-positives had significantly greater attention/concentration impairment than HIV-negative persons. In conclusion, taking into account psychopathological dimensions may help psychiatrists in clinical decision-making regarding the differential diagnosis of psychotic symptoms. The psychopathological pattern of first-episode psychosis in HIV-positive patients may represent an 'elementary model' of acute psychosis characterized by paranoid delusions in the absence of the usual affective symptoms.

HIV prevalence among first‐presentation psychotic patients

“…With regard to first‐episode psychosis in the HIV‐seropositive population, previous studies were predominantly of small sample size, only included subjects with either functional or organic psychosis and were conducted in settings with a much lower HIV prevalence than ours .…”

“…In a study by De Ronchi et al . that included a total of 22 HIV‐positive and HIV‐negative patients who presented with a first episode of psychosis secondary to an organic cause, the mean age, unemployment rate and mean CD4 cell count were similar to findings from this study; however, only 16.7% of subjects in that study had been initiated on ART , compared with 55.6% in this study. The improved ART usage in subjects in the present study may be attributed to the fact that De Ronchi et al .…”

“…South Africa, with more than 6.4 million seropositive individuals and an HIV prevalence of 18.9% among adults, has the largest number of HIV‐infected people in the world . Previous studies have reported a higher HIV prevalence as well as an increase in HIV risk‐taking behaviour among individuals with psychosis .…”

Hallucinations: A Systematic Review of Points of Similarity and Difference Across Diagnostic Classes

“…26,27 Endocrine-related metabolic disorders including disorders of thyroid function 28 and Hashimoto disease 29 can produce hallucinations, as can deficiencies in D and B12 vitamins. 30,31 Other medical conditions associated with hallucinations include chromosomal disorders such as Prader–Willi syndrome, 32 autoimmune disorders, 33 and acquired immunodeficiency disorders such as HIV/AIDS, 34 and sleep disorders such as narcolepsy. 35 Neurological events such as tumors, 36,37 traumatic brain injuries, 38 epilepsy, 39 and cardiovascular events may also cause hallucinations where activity involves the brainstem regions and areas involving the temporal, occipital, or temporo-parietal pathways.…”

Management of common psychiatric conditions in the HIV-positive population

“…Although characteristics of HIV-related psychosis are likely to be consistent with primary psychiatric psychosis, with symptoms of thought disorder, delusions, and perceptual disturbances, HIV-infected patients with psychosis may be more likely to have paranoid delusions in the absence of affective symptoms [34]. Because of the increased potential for extrapyramidal side effects in HIV-infected patients on conventional neuroleptics [35], high-potency D2-blocking agents should generally be avoided in favor of atypical antipsychotics.…”