The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 10: Psychiatric ProblemsTreatment of Late-Stage DementiaHIV subcortical dementia may progress to a global dementia in the later stages. At this point, apatient’s26intellectualpicasfunction, decisionmaking capacity and behavioral control may be impaired.Psychostimulants should be evaluated often and decreased if there are signs of agitation orexcessive motor activity. Late-stage dementia is often complicated by concurrent delirium dueto medications, metabolic disturbances, or acute infections. Agitation and psychotic featuressuch as hallucinations or paranoia can best be treated with risperidone and/or lorazepam. If anoral route of administration is not possible, IV haloperidol (.25 to 1mg) and IV lorazepam may behelpful in controlling agitation and psychotic features.Treatment of Cognitive Disorders in ChildrenThere are limited studies of AZT and ddI showing improvement in children with AIDS and thatfor the most part, these medications are well tolerated. 40,41,42 While psychostimulants have notbeen systematically studied in children and adolescents with HIV, there is a long medical experiencewith them in treating attention deficit disorders in children and adolescents.Delirium and the Impact of Medications on Central Nervous System FunctionDelirium in the HIV-infected patient can result from acute primary HIV infection of the brain,consequences of infections, metabolic derangement, medications, and acute substance intoxicationor withdrawal, and is more likely in the setting of advanced illness or hospitalization. 43,44Hypoxemia due to pneumocystis carinii pneumonia may cause an acute change in mental state,as can uremia secondary to HIV nephropathy or elevated ammonia levels due to hepatic disease.Table 10-16 lists common side effects of medications used in the care of the HIV-infected patientthat also must be considered. 45Intoxication or withdrawal from either prescribed or non-prescribed medications must be ruledout. There can be multiple causes of acute changes in mental status. If the delirious conditiondoes not improve with treatment for an obvious potential cause, the clinician must look forother co-morbid conditions.222U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau