dr chioni siwo m.med (psych) 2nd year student university of zambia 2012
TRANSCRIPT
Secondary Mania in HIV Dr Chioni Siwo
M.Med (Psych) 2nd year studentUniversity of Zambia
2012
GOOD MORNING
OUTLINEWhat is it Secondary Mania (in HIV)?PrevalenceCausesClinical PictureTreatment Gaps in literatureProposed study
What is it?Manic-like disorder occurring as a direct
effect of the HIV infection
No delirium
No prior history of Bipolar disorder or Major Depressive disorder.
Otherwise has DSM-IV manic-like symptoms
Prevalence
Not known globally
Not known in sub-Saharan Africa
Study by Owen Larsson et al in Australia showed a prevalence of 8% over 17 months
Most common cause of admission to psychiatric hospital in Uganda especially females
Causes• Medication e.g. Isoniazid, anti-depressants, steroids
• Direct Insult to the brain e.g. traumas, strokes, tumours
• Systemic Disorders such as Hyperthyroidism, Hyperparathyroidism
• Substance Abuse
Clinical Picture Study by Ethel Mpungu et al in Uganda in
2006, found that HIV positive patients with Mania were:
found to have more manic symptoms (YMRS)
more irritable
more aggressive and disruptive
Clinical Picture contd… more talkative and had decreased need for
sleep
had more delusions, auditory and visual hallucinations
mostly female
Treatment
Studies have reported the use of Haloperidol and Diazepam in acute phase
It was found that HIV patients with secondary mania responded in 2 weeks or less than
• Patients with Secondary mania in HIV respond faster to antipsychotic drugs than patients with Bipolar mania
Gaps in the scientific literature• Do they benefit from continued anti-manic
medication?
• Do they have a complete recovery? In particular do they function behaviourally, socially, and occupationally?
Proposed studyCase Series of 30 patients with secondary
mania HIV followed up for 6 months
Focusing on clinical, biological and psychosocial measures
Results will be analyzed for patterns in the illness and this will help with future management of patients
ObjectiveTo gain greater knowledge of the secondary
mania, its clinical and psychosocial correlates and its response to treatment.
• To improve the management of patients by using evidence based management interventions including treatment of associated physical health conditions.
Also to get a better understanding of the burden of disease resulting from this mental disorder in HIV
MethodologySITE A case series of 30 patients will selected
from Chainama Hospital (Zambia’s only psychiatric tertiary hospital) and University Teaching Hospital (HIV) clinic both in Lusaka
SETTING It will be a longitudinal study observing
progress of the cases from commencement over a period of 6 months
Methodology contd…..Selected clinical observations will be made
at 1, 3 and 6 months
Family will be included
Selection: patients will included upon meeting DSM-IV criteria A-D for manic episode
MeasuresSemi-structured Psychiatric interview of
patient
Young’s mania rating scale
AUDIT a measure of alcohol intake
MMSE
Measures contd…
Measure of behaviour in home circumstances – semi-structured interview
Semi-structured interview of informants e.g. relatives
• For female patients menstrual cycle will be included
Measures contd…Physical examination
For female patients menstrual cycle will be included
CD4
Sputum for AAFB, CXR
C-Reactive protein
FBC/ESR
Measures contd…LFT, Creatinine
RPR
Renal function
Nutritional status and BMI
MRI of brain – near first episode when any secondary mania neuropathology may be detectable
EthicsApproval will be sought from the University
of Zambia Research and Ethics Committee
Informed consent will be sought from the participants
There may be issues of confidentiality in the follow up and the involvement of the relatives when a manic patient may not be able to give informed consent
Limitations of the Study
There will be a bias in the case selected in that uncooperative patients and relatives will be excluded
No intervention will be evaluated, study will
not lead directly to improvement of patient management.
No epidemiological conclusions can be drawn
Acknowledgements
Dr Ravi Paul, HOD, Department of Psychiatry, School of Medicine, UNZA
Dr Gil Blackwood Honorary Lecturer, School of Medicine, Department of Psychiatry, UNZA
ReferencesE Nakimuli-Mpungu, S Musisi Clinical presentation of Bipolar
mania in HIV positive patients in Uganda Psychosomatics 50:4 July-august 2009
Nakimuli-Mpungu, S Musisi Early onset versus late onset HIV related secondary mania in Uganda Psychosomatics 49:530-534 2008
E Nakimuli-Mpungu, S Musisi Primary mania versus HIV related secondary mania in Uganda American Journal of Psychiatry 163:8, August 2006
Owen-Larsson HIV infection and Psychaitric illness African Journal of Psychiatry Volume 12, no.2 2009
Charles Krauthammer, MD; Gerald L. Klerman Secondary mania Arch Gen Psychiatry 35(11):1333-1339, 1978
THANK YOU!