Am J Psychiatry 1990; 147:696-710
Copyright © 1990 by American Psychiatric Association
Organic mental disorders caused by HIV: update on early diagnosis and treatment
SW Perry
Department of Psychiatry, Cornell University Medical College-The New York Hospital, NY 10021.
HIV directly affects the CNS, primarily causing subcortical neuropathology.
Dementia as the initial presentation is rare, but organic mental changes
that mimic many functional disorders can occur during the course of
infection. The mental status examination is not adequately sensitive to
detect noncognitive dysfunction, and subjective complaints, neurological
signs, reduced T4 lymphocytes, CSF abnormalities, diffuse slowing on ECG,
mild cerebral atrophy on brain CT, and nonspecific hyperdensities on brain
magnetic resonance imaging do not correlate reliably with early and subtle
HIV-induced neuropsychological impairment. Zidovudine (AZT) can delay or
reverse mental deficits, and psychostimulants can reduce apathetic
withdrawal, but high-potency neuroleptics can cause neuroleptic malignant
syndrome.
