Psychiatric symptoms as primary manifestation of HIV infection

The prevalence of psychiatric symptoms a nd disorders in HIV-infected patie nts is high. The differential diagnosis includes psychoreactive disorders, acute psychiatric symptoms of an HIV-associated encephalopathy,and symptoma tic psychotic illnesses due to secondary neurologic manifestations such as opportunistic central nervous infections and intracerebral lymphoma. Clinic al aspects and psychopathological findings are not sufficient for different ial diagnosis and identification of primarily psychiatric disorders. Second ary neurologic manifestations causing a symptomatic psychosis must be exclu ded as soon as possible by brain imaging (CT,MRI) and analysis of the cereb rospinal fluid. In emergency situations, however, German law imposes strict regulations, especially in the case of sectioned patients. These medical a nd medicolegal questions are illustrated by case reports and propositions f or an effective strategy are made.