Prevalence and clinical presentation of HIV positive female psychiatric inpatients

Literature on the prevalence and clinical presentation of South African psychiatric HIV positive patients as well as their management is lacking. This study was performed to investigate these parameters.

A prospective study to investigate the prevalence and clinical presentation of HIV positive psychiatric female patients admitted to an acute ward (female psychiatric ward Cecilia Makiwane Hospital, East London Hospital Complex) was undertaken for a one year period from June 2009 to May 2010. Additional factors such as demographic profile, associated substance abuse, pre-existing psychiatric disorders and management were also studied.

During this one year period 158 female patients were admitted to the acute female psychiatric ward for assessment and treatment. Of these 158 admissions 21 (13%) were HIV positive, but only 19 (12%) consented to the study. Ten of the 19 HIV positive patients (53%) had an Axis I diagnosis of a psychiatric disorder secondary to HIV, most commonly mood disorder (mania) with psychotic symptoms. Nine of the 19 HIV positive patients (47%) had a pre-existing primary psychiatric diagnosis, most commonly Bipolar Disorder, recent episode mania with psychotic symptoms. The most common psychotic symptoms were grandiose delusions followed by auditory hallucinations, paranoid delusions and visual hallucinations. The most common mood symptom was euphoria. Substance abuse was uncommon amongst the patients in the study group. Sixteen of the 19 patients (84%) were on antipsychotics, 14 of these 16 patients were on haloperidol. The most commonly used mood stabilizer was sodium valproate.

In this study mania with psychotic symptoms was the most common presentation in both the group with a pre-existing primary psychiatric disorder and in the group without a primary psychiatric disorder. The prevalence of HIV positive admitted psychiatric females in this study was 12%. Co-morbid substance abuse was uncommon. Most patients tolerated low doses of typical antipsychotics in combination with a mood stabilizer (valproate being the most common).