Neuroleptic Treatment of HIV-Associated Psychosis

Abstract

The aim of this rater-blinded randomized study was to evaluate the efficacy and side effects of haloperidol and thioridazine in the treatment of new-onset psychosis in HIV-positive individuals. Participants were 13 men who had no history of psychosis prior to infection with HIV, and whose psychosis was not attributable to delirium or to non-HIV-related organic factors. Participants were evaluated at baseline after at least one month without neuroleptic treatment and then weekly for six weeks of the experimental treatment using several rating scales. The mean daily dose in chlorpromazine equivalents was

Neuropsychiatric Aspects of Infectious Diseases

“…Agents reported in the literature include haloperidol (mean dose, 3 mg), 73 clozapine (mean dose, 27 mg/d), 74 risperidone (mean dose, 3.3 mg/d), 75 and olanzapine (10–15 mg/d). 76 Haloperidol was reported to have a high incidence of EPS and caution is encouraged with clozapine because of the risk for agranulocytosis and interaction with ritonavir.…”

Neurobehavioral Manifestations of Human Immunodeficiency Virus/AIDS

“…This must be weighed against the potential disadvantages of other mood stabilizers, such as lithium, which can exacerbate renal disease, or carbamazepine, which can induce bone marrow suppression, hepatotoxicity, and induce the metabolism of ART (particularly protease inhibitors) 22,24,25 . Likewise, the older, high potency dopamine receptor 2 (DA2) blocking agents have been reported to cause serious extrapyramidal movement disorders and neuroleptic malignant syndrome in AIDS patients 26,27 . Atypical antipsychotics, such as risperidone, clozapine, ziprasidone, quetiapine and olanzapine are frequently used to manage psychosis in HIV+ patients 28,29 ; however, they are associated with development of metabolic syndrome, cardiac problems and obesity, and may require dose adjustment if they are used with the protease inhibitor ritonavir 30,31 .…”

“…Open-label studies and case reports suggest that the atypical antipsychotics clozapine, risperidone, and ziprasidone benefit AIDS patients with psychosis and/or delirium 16 . Some would argue that the use of older, D2-blocking antipsychotics should be avoided as first-line treatment in AIDS patients, due to reports of neuroleptic malignant syndrome and extrapyramidal movement disorders 26 .…”

Practice Guideline for the Treatment of Patients With HIV/AIDS

“…HIV can affect other areas of the nervous system, causing syndromes such as painful sensory peripheral neuropathy or vacuolar myelopathy of the dorsolateral columns of the spinal cord. There are limited data in support of HIV infection of the CNS resulting in syndromes such as psychosis (31) or mania (32)(33)(34).…”

“…New-onset psychotic symptoms have been reported in HIV-positive individuals in the absence of medical/iatrogenic causes or concurrent substance abuse (42,43). One case-control study systematically examined patients with HIV infection that predated the onset of psychosis (31). In this study, the psychotic subjects had significantly higher rates of past stimulant and sedative-hypnotic abuse and higher mortality at follow-up.…”