Neuropsychiatric disorders
Treatments for the Neuropsychiatric disorders associated with AIDS:
Mild Neuro-cognitive disorder
- No confabulation
- Difficulty concentrating, unusual fatigue, subjectively slowed down, difficulty in remembering, learning and recalling new info
- Difficulty problem solving, abstract reasoning, and slowin of simple motor performances (finger tapping)
- Be sure to distinguish from delirium and dementia (these have confabulation)
Psychopharmacology – in addition to their usual HIV meds, stimulants (ie, methylphenidate) could be used – BE CAREFUL with drug interactions (CYP 3A4 & CYP 2D6)
HIV Associated Dementia – Signs and Sx
- The cognitive abnormalities in a person with dementia are more profound and more generalized than in persons with mild neuro-cognitive disorder
- Marked mental slowness and deterioration
- With disease progression, pt becomes more apathetic, severely disoriented, and frankly confused
- Slow onset, long lasting
- Difficulty in ADL’s
- Increased irritability, mood lability, delirium, paranoid ideations, auditory and visual hallucinations
- Neuroradiological exam – cortical atrophy (sulci dilation); EEG shows diffuse slowing
- Lab findings – low CD4, increased CSF neopterin and increased CSF quinolinic acid (proteins); ↑ CSF viral load correlated to severity of the dementia
- Course and Prognosis – about 50% of patients diagnosed with AIDS have either asymptomatic neuropsych impairment or mild neurocognitive disorder; poor prognosis
- Treatment
SSRI’s
- Cytalopram (Celexa)
- Escitalopram (Lexapro)
- Paxil (Buroxitine)
- Venlafaxine (Effexor) – good but be careful with the side effects
- Mood Stabilizers
- Valproic acid, and Gabapentin ( NOT Lithium!!)
- Anti-psychotics
- NOT low potency anti-psychs or Clozapine
- Benzodiazepine
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- Esp. short acting or ultrashort acting
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- No TCA’s or buproprion (↓ metab can cause toxicity)
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- DO NOT USE Sertraline (↑ GI probs), FLuoxetine (can cause serotonin syndrome and has ↑↑ drug interactions CYP 2D6);
Tags: Cytalopram, FLuoxetine, HIV Associated Dementia, Mild Neuro-cognitive disorder, Mood Stabilizers, Sertraline
