n South African Psychiatry Review - Acute psychiatric in-patients tested for HIV status : a clinical profile : original article




To obtain a retrospective profile of the clinical presentation, inpatient management and their initial access to HAART of service users tested for HIV status while admitted to an acute bed psychiatric unit.

A retrospective clinical audit of HIV positive service users' discharge data sets was undertaken for the year September 2003 to August 2004. Data was compared with existing literature.
During the study period a total of 443 service users were admitted of whom 17.4% (n=77) were tested for HIV status. Of these, 7.7% (n=34) of the total admissions tested positive. Presenting psychiatric symptoms included elevated mood, psychosis, disorganized behavior, confusion, aggression and mutism. The most common DSM IV diagnoses were mood disorder or psychosis due to general medical condition. Predominantly risperidone and haloperidol in combination with valproate were used in treatment and at relatively high dosages.
Amongst HIV positive service users acute psychiatric symptoms almost exclusively consisted of associated psychosis or manic symptoms rather than depression. The clinically successful addition of valproate to antipsychotic medication in 50% of cases in this study requires further research to establish if it could also be recommended on the basis of empirical findings. Service users' capacity to adhere to strict treatment regimes might have been affected if not supervised, in view of their generally low global assessment of functioning (GAF) scores on discharge.


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