Development of acute psychotic disorders and HIV-1 infection

Objective; To gain more understanding about the relationship between human immunodeficiency virus type 1 (HIV-1) infection and new-onset psychosis, we compared clinical and immunological findings, psychiatric symptoms, global cognitive performance and, when available, computerized tomography (CT) fi ndings between HIV-1-seropositive patients with new-onset psychosis and wel l-matched nonpsychotic HIV-1-seropositives. Methods: Two groups of subjects : HIV-1-seropositives with new-onset psychosis (n = 12) and HIV-1-seroposit ives without psychosis (n = 15) were recruited through outpatient departmen ts. Organic Delusional Syndrome and Organic Hallucinosis were clinically di agnosed using DSM-III-R diagnostic criteria. Of the baseline participants, twenty-two participated in the two-year follow-up examination. Results: The prevalence of new-onset psychosis in HIV-1-infected subjects was 3.7 per 1 00 (95% C.I. = 1.6-5.7). HIV-1-seropositive persons with new-onset psychosi s had more frequently a positive past psychiatric history, no antiretrovira l therapy, and a lower global cognitive performance than did the nonpsychot ic HIV-1-seropositives. CT was positive, showing generalized brain atrophy, in three out of nine patients. Remission of psychotic symptoms was observe d only in two HIV-1-seropositive persons with new-onset psychosis. Death oc curred in two psychotic HIV-1-seropositives with simple loosely held delusi ons. Autopsy results showed that cortical sulci and ventricle size were gra ded as with moderate/severe enlargement. Conclusions: New-onset psychosis i n HIV infected patients could raise considerable problems in deciding wheth er a presentation is organic or functional. An interaction of the disease o r of psychologically "having" the disease with the presence of a psychotic reaction should also be considered. Interestingly, a protective effect of a ntiretroviral therapy for new-onset psychosis is suggested.