Assessment and management of the AIDS patient with neuropsychiatric disturbances

The studies reviewed here and ongoing work indicate a primary role for psychiatry in treating patients with the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection. Those patients often have neuropsychiatric disorders concurrent with the complications of physical disease. It is important to understand the diagnostic criteria for patients with HIV-related disorders to distinguish CNS disturbances caused by infections from those psychiatric problems exacerbated by the social consequences of the syndrome. Although treatment is difficult in immunocompromised patients and treatments may cause serious side effects, many of the CNS symptoms of AIDS patients can be treated in the same way as other diseases of the CNS. Psychostimulants are the most promising therapeutic agents for AIDS patients. In the treatment of psychotic episodes, high-potency neuroleptics at low dosages have been used successfully. In all therapies, careful consideration must be given to possible adverse reactions, which may be more serious in HIV-related diseases.