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 ProblemsConduct-Behavioral (Externalizing) Disorders in Children and AdolescentsAttention problems in children with HIV may be a direct consequence of HIV infection andCNS complications.26 picas70 Treatment of attention deficits in HIV-positive children is similar to treatmentin non-infected children. Psychostimulants and alpha agonists can be effective. 71 Socialskills training can help children with HIV with attention deficits cope with stigma.Conduct disorders and substance abuse are common among HIV-positive adolescents. 57 Treatmentmust be specialized to reduce psychiatric morbidity and decrease associated risk-takingbehaviors. (See Chapter 11: Substance Use Problems.)Sleep DisordersSleep disorders are common and distressing, and exacerbate other symptoms associated withHIV such as fatigue, cognitive impairment, memory loss, decreased work performance, diminishedcoping capacity, and reduced social interaction. 72,73 Sleep disturbance can contribute topoor adherence, failure to engage in treatment, relapse of substance use in the attempt to selfmedicate,poor impulse control and impaired judgment. Treating sleep disorders in people withHIV is not only helpful to the patient in terms of reducing fatigue, but also enhances the treatmentalliance.In HIV, sleep disturbance is marked by shorter total sleep time, longer sleep onset latency,reduced sleep efficiency, more frequent awakenings and more time spent awake. The impact ofsleep deprivation becomes more significant as illness progresses and stamina and energy decline.Sleep pathology has been associated with growth hormone dysregulation. 74,75 Hypersomnia, associatedwith advanced disease, may be related to elevated levels of TNFa. The differential diagnosisof sleep disturbance appears in Table 10-24.Table 10-24: Differential Diagnosis of Sleep Disorders in HIVX• Primary insomnia• Primary hypersomnia• Narcolepsy• Circadian rhythm disturbance• Parasomnias• Major depressive disorder• Generalized anxiety disorder• Adjustment disorder with anxious mood• Mania• Delirium• Alcohol/substance abuse• Caffeine• Acute stress of hospitalization or bereavement• PainU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 237