Case series of mania secondary to HIV/AIDS in patients at Chainama Hills College Hospital and University Teaching Hospital Lusaka, Zambia
Date
2015-11-24
Authors
Siwo, Chioni
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Abstract
Primary mania is the diagnostic label given to manic episodes that occur during the course of a Bipolar Disorder (Ghanem KG, 2008). Patients with secondary mania have manic-like episodes somewhat similar to those seen in Bipolar Disorder. (Lyketsos CG et al, 1997). However, these manic-like episodes are secondary to other causes such, as a side effect of medication or a reaction to a brain insult (Ellen S et al, 1999). Manic symptoms occurring in HIV Disease are well recognized complications of HIV infection of central nervous system (Kooistra B, 2009). Patients with mania can be divided into 2 groups, those with pre-existing Bipolar Disorder and those with secondary mania as a consequence of HIV brain involvement (Fishman M, 1996). The previous studies have shown that there is a difference with Bipolar Disorder mania and mania secondary to HIV in both its symptom profile and severity. Mania secondary to HIV is characterized by irritability rather than euphoria. HIV positive patients with secondary mania were more likely to be immunologically suppressed with low CD4 counts, than HIV negative patients with mania.
A case series of patients suffering from secondary mania due to HIV/AIDS was carried out at Chainama Hills Hospital, and University Teaching Hospital, Lusaka. The general objective of the study was to gain the greater knowledge of the mania secondary to HIV/ AIDS while specific objectives were to determine whether the specific clinical characteristics of mania secondary to HIV identified in previous studies are also found in Zambian patients and to determine whether patients with secondary mania have increased irritability. Patients with acute manic episodes were admitted to Chainama Hills College Hospital and University Teaching Hospital. Ten patients were recruited
during a period of 2 months. They were assessed for symptom severity, demographic and clinical characteristics of interest at the time of recruitment in the study and followed up at 4 weeks and 8 weeks. The patients were given routine care and treatment during their stay in the hospital, which included HAART, antipsychotics as well as mood stabilizers. Six out of ten patients were females and four were males. The minimum age of the participants was 19 years; the maximum age was 48 years while the average age was 35.3 years. The minimum CD4 count was 3; the maximum CD4 count was 319 while the average CD4 count was 156.00 (SD142.45); median was 152.50. CD4 count of four participants was unavailable. The Young Mania Rating Scale scores were calculated at the time of recruitment and at the time of follow up at 4 weeks and at 8 weeks after discharge. The mean YMRS at the time of follow up (8weeks) was zero while YMRS at time of follow up (4 weeks) was 12.40(SD 6.85), which was significantly lower than mean YMRS at the time of recruitment42.70 (SD 8.44), (t=5.724; df=9; p=0.001; <0.05). Furthermore, the mean Irritability Score on YMRS at time of follow up (8weeks) was zero while at the time of follow up (4weeks),it was 2.40(SD 2.06), which was significantly lower than mean Irritability Score on YMRS at the time of recruitment 5.20(SD 2.7), (t=3.674; df=9; p=0.005; <0.05).This shows that use of anti-psychotics, mood stabilizers and initiation of HAART in patients with mania due to HIV is effective in the management of these patients.
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Keywords
Manic-depression illness , Depression, mental , HIV/AIDS(Disease)-Lusaka,Zambia , Manic disorders-drug therapy