Development of acute psychotic disorders and HIV-1 infection.
OBJECTIVE
To gain more understanding about the relationship between human immunodeficiency virus type 1 (HIV-1) infection and new-onset psychosis, we compared clinical and immunological findings, psychiatric symptoms, global cognitive performance and, when available, computerized tomography (CT) findings between HIV-1-seropositive patients with new-onset psychosis and well-matched nonpsychotic HIV-1-seropositives.


METHODS
Two groups of subjects: HIV-1-seropositives with new-onset psychosis (n = 12) and HIV-1-seropositives without psychosis (n = 15) were recruited through outpatient departments. Organic Delusional Syndrome and Organic Hallucinosis were clinically diagnosed using DSM-III-R diagnostic criteria. Of the baseline participants, twenty-two participated in the two-year follow-up examination.


RESULTS
The prevalence of new-onset psychosis in HIV-1-infected subjects was 3.7 per 100 (95% C.I. = 1.6-5.7). HIV-1-seropositive persons with new-onset psychosis had more frequently a positive past psychiatric history, no antiretroviral therapy, and a lower global cognitive performance than did the nonpsychotic HIV-1-seropositives. CT was positive, showing generalized brain atrophy, in three out of nine patients. Remission of psychotic symptoms was observed only in two HIV-1-seropositive persons with new-onset psychosis. Death occurred in two psychic HIV-1-seropositives with simple loosely held delusions. Autopsy results showed that cortical sulci and ventricle size were graded as with moderate/severe enlargement.


CONCLUSIONS
New-onset psychosis in HIV infected patients could raise considerable problems in deciding whether a presentation is organic or functional. An interaction of the disease or of psychologically "having" the disease with the presence of a psychotic reaction should also be considered. Interestingly, a protective effect of antiretroviral therapy for new-onset psychosis is suggested.
de Ronchi
D
D
Institute of Psychiatry, Medical School, University of Bologna, Italy. deronchi@alma.unibo.it
Faranca
I
I
Forti
P
P
Ravaglia
G
G
Borderi
M
M
Manfredi
R
R
Volterra
V
V
D015526:AIDS Dementia Complex / Q000175:diagnosis; D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis; D000208:Acute Disease; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology* / Q000821:virology; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D019965:Neurocognitive Disorders / Q000175:diagnosis / Q000821:virology; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D016019:Survival Analysis; D016896:Treatment Outcome
D000998:Antiviral Agents; D017320:HIV Protease Inhibitors