Beruflich Dokumente
Kultur Dokumente
METHODS
Mania
Twenty
Constantine
G. Lyketsos,
Joseph
Schwartz,
Marc
Glenn
M.D.,
M.H.S.
M.D.
Fishman,
Treisman,
consecutive
were
referred
tient
vice
M.D.
M.D.,
clinic
(APS)
manic
Ph.D.
patients
for
of the Johns
and who
met
episode
with
psychiatric
were
HIV
infection
evaluation
Hopkins
DSM-III-R4
included
who
to the
outpa-
AIDS
Psychiatry
criteria
for
in the
study.
Sercurrent
The
setting
Twenty
patients
with
HIV
infection
and
mania
obtained.
All
study
were grouped
according
to whether
their first
manic episode occurred
when CD4 count was
<200
(late onset) or
200 (early onset).
The lateonset patients
were less likely to have personal
or
family
histories
of mood disorder
and more likely to
have dementia
or cognitive
slowing.
They also exhibited a different
manic symptom
profile. The dif-
days
of the index
All participants
ferent sociodemographic
and symptom
profiles
associated
with early-onset
and late-onset
mania
may reflect differences
in patho physiology.
cess,
(The
Journal
of Neuropsychiatiy
Neurosciences
1997;
and
sive neuropsychiatric
tionally,
they
Clinical
and
to
syndromes
occur
with
higher
AIDS.12
Manic
of HIV
inversely
disease
are
associated
mood
areas,
the
context
the
lifetime
20 patients,
first lifetime
a clear
Clinical
of HIV
frequencies
syndromes
after
with
onset
associated
with
with a personal
syndromes
infection
quences
mania
are
of mood,
with
an
a distinct
onset
late
condition
onset
in the
dementia
or family
the
caused
of
course
but
history
subcortical
are important
possible
in
tend
that
are
of
brain
to
manic
course
of HIV
by the conse-
and
pathophysiology.
The goal
of this
mographic
and
study
clinical
and late-onset
infection.
We
work
indicating
nia and
dementia
personal
or family
JOURNAL
OF
symptom
would
differences
an
was
profiles
of patients
manic
episodes
also
sought
to
association
and
an
history
NEUROPSYCHIATRY
in the
replicate
the
of mood
disorders.2
by APS.5 Addithe
Structured
diagnoses
or absence
of individual
Family
and personal
histories
also ascertained.
During
this
of mania
was
dated.
For
onset
of mania
several
years
before
of
pro-
13 of the
the
4 had
their
date
of
2 had their
first manic
episodes
and CD4 counts
at the time of the
onset
available
of mania
the
were
onset
of mania
infection
For
to CD4
count
with accuracy,
and
his data
from
the analyses.
A detailed
taken
to stage
each
patients
according
to Centers
(CDC)
criteria.7
In this way,
first lifetime
onset
of mania
Eighteen
participants
also
psychological
testing
battery
and
other
the clinical
records.
in relationship
could
not be determined
were
therefore
excluded
medical
history
was also
HIV
in hospital
for
Disease
Control
it was possible
to date the
in relation
to CD4 count.
underwent
a 1-hour
neurothat included
the Grooved
measures.
examinations,
On
the basis
the presence
of
these
or ab-
or not exhibiting
performance.
significant
slowing
early-
context
previous
between
late-onset
inverse
association
comprehen-
used
with
the index
episode
of mania
represented
onset.
Of the remaining
participants,
fied as exhibiting
in psychomotor
sociode-
with
standard
to confirm
presence
30
sence
of dementia
by DSM-III-R
criteria
was
determined.
On the basis
of performance
on the Grooved
Pegboard
(average
of dominant
and nondominant
performance
based
on 1-scores),
participants
were
classi-
profile.
A demonpoint
to a distinct
to compare
onset
DSM-III-R
within
HIV infection.
Another
within
the past year,
Pegboard
tests and
of HIV brain
infection.
If this is true, late-onset
might
differ
from early-onset
mania
in its associ-
ated sociodemographic
stration
of such
onset
HIV
it appears
the
late
disorder.2
Given
that HIV affects
such as the caudate
nuclei,3
that
regulation
infection
the
symptoms
of mania.
mood
disorders
were
9:277-279)
in the
for
to determine
occurred
examination
examined
were
Interview
patient,
Manic
examinations
manic
episode.
underwent
the
Paexwas
of
Group,
The
correspondence
mawith
Received
February
2, 1996;
From
the AIDS
Psychiatry
Baltimore,
Copyright
Johns
MD
revised
Service
May
and
Hopkins
University,
to Dr. Lyketsos,
Osler
1, 1996; accepted
Neuropsychiatry
Baltimore,
320, The Johns
May
and
Maryland.
Hopkins
13, 1996.
Memory
Address
Hospital,
21287
1997
American
Psychiatric
Press,
Inc.
277
CLINICAL
AND
RESEARCH
In the analyses,
groups:
those
with
REPORTS
participants
early-onset
were
mania,
their
was
CD4
count
<200.
We
divided
if mania
their
onset
used
into
two
occurred
this
cutoff
because
that
is below
allow
200.
onset
and
sociodemographic
were
profiles
compared
by using
cases
clinical
and
1.
Comparison
of sociodemographic
and historical
profiles of 20 patients
with manic
syndrome
of early or late
onset
in the context
of HIV infection
CD4 count
was
occurred
when
of current
CDC recommendations
nosis
of AIDS if the CD4 count
late-onset
TABLE
to compare
continuous
variables
and chi-square
tests to
compare
categorical
variables.
The sample
size was too
small
to allow
factor-analytic
study
of the clustering
of
mania
symptoms.
Late
Variable
(n
35.5
Heterosexual
Bijhomosexual
Intravenous
contact
drug
use
at evaluation
CDC stage
I
III
Family
history
disorder
Eight
patients
were
nia and 11 as having
comparison
classified
late-onset
of the
as having
mania.
early-onset
sociodemographic
and
and
other
early-onset
Table
1 shows
late-onset
clinical
could
be expected
from
and late-onset
cases were
the way
defined.
all
had
slowing
on
the
far lower
rates
cases.
the comparison
late-onset
groups
profiles.
In general,
on
the
the
for irritability,
late-onset
was more
group,
common
and were
of mood
dementia,
Grooved
of the
as
impairment
manic
groups
appeared
two
less
disand
early-onset
and
symptom
to have
patients
had more
sympin a significantly
higher
differences
were
most
prowas
for increased
in the early-onset
more
common
in the
talkativeness,
group.
%)
history
of mood
(lifetime,
%)
Presence of
dementia
Slowing on
Pegboard
5.5
0.75
50.0
0.14
36.3
87.5
0.026
2.9
10.6
1.3
0.12
9.1
36.4
54.5
12.5
0.0
87.5
0.16
9.1
18.2
72.7
62.5
12.5
25.0
0.043
50.0
90.1
0.043
DSM-III-R
(%)
Grooved
(%)
18.8
100.0
aCompared
0.0004
60.0
0.0
0.0073
90.0
12.5
0.001
or chi-square
test
(all others).
Pegboard,
of cognitive
which
and
late-
early-onset
individu-
DSM-III-R
different
profiles.
Late-onset
toms,
which
were
reflected
mean
symptom
count.
The
nounced
on
The
in which
Late-onset
als were
less likely
to be African
American
likely
to have
personal
or family
histories
orders.
They
also
had
higher
rates
of
compared
with
in the early-onset
Table
2 shows
patients
variables.
likely
to have
clinical
AIDS
stages
of HIV disease,
as
onset
patients
were
more
and were
in more
advanced
almost
mathe
34.7
Pa
of mood
(first degree,
Personal
disorder
5.2
8)
(%)
IV
RESULTS
(n
81.8
12.5
contact
Early
11)
which
TABLE
Comparison
of 20 patients
with manic syndrome
in the
context of HIV infection
on individual
and cumulative
DSM-III-R
manic
symptoms
by time of mania onset
2.
Manic Symptom
(DSM-III-R)
Late (%)
(a = 11)
Early (%)
(a = 8)
Pa
Euphoria
81.8
77.8
0.82
Irritability
81.8
81.8
81.8
63.6
33.3
0.02
77.8
0.82
55.5
0.20
0.04
Grandiosity
Decreased
sleep
Increased talk
Flight of ideas
Distractability
Increased
Poor
activity
judgment
Psychotic symptoms
Mean number of
symptoms
SE
aComped
100
81.8
66.7
0.43
72.7
44.4
0.19
62.5
37.5
0.18
63.6
55.6
0.71
36.4
44.4
0.71
7.1 0.44
by f-test (mean
5.8 0.40
or chi-square
number)
0.04
test (individual
symptoms).
DISCUSSION
In this
consecutive
study
and mania,
we have
gesting
that
patients
late-onset
mania
and
psychiatric
of patients
in HIV
histories.
278
4 times
of HIV
HIV
infection
findings2
and
those
sugwith
infection
differ
in their personal
We have
also confirmed
the
association
between
late-onset
The prevalence
of dementia
cases
was
prevalence
with
replicated
previous
with
early-onset
higher
dementia
mania
of 60%
than
in
and
the
the expected
in AIDS
(which
dementia.
late-onset
lifetime
is about
15%
8)
Thus,
the
and dementia
Our results
association
is not likely
also indicate
ciated
with
psychomotor
associated
with
mania,
prevalence
of
than what
has
in the absence
mania
is typically
between
late-onset
to be due to chance
that late-onset
mania
mania
alone.
is asso-
slowing,
which
is not usually
in the absence
of dementia.
The
psychomotor
slowing
is
been
reported
in late-stage
of mania.8
It is also unexpected
thought
VOLUME
of as a syndrome
#{149}
NUMBER
much
HIV
higher
infection
given
that
of excessive
2 #{149}
SPRING
1997
CLINICAL
activation
prevalence
with
rapid
of manic
thoughts
symptoms
and flight
of ideas.
The
in this series
of patients
was quite
high,
particularly
with
regard
to grandiosity,
which
may reflect
the fact that this was a sample
of cases
selected
out of a tertiary
clinical
center.
The finding
that
patients
tom
less
sis
with
profile,
likely
that
late-onset
mania
were
more
likely
to be hypertalkative
late-onset
mania
had
a broader
to be irritable,
supports
the
is different
from
work
was
annual
meeting
Newport,
propose
that
late-onset
phase,
or it may
mania
be
1. Kieburtz
AIDS.
early-onset
by
which
manifestation
individuals.
the
fact
we
term
mania
intimately
tied to
brain
infection.
Early-onset
mood
disorder
in its manic
a different
in HIV-asymptomatic
sis is supported
mania,
that
early-onset
Am
Lyketsos
K, Zettelmaier
J Psychiatry
CG,
mania
our understanding
mechanisms
involved
sodes
JOURNAL
of
some
in the
was
in general.
OF
NEUROPSYCHIATRY
4.
regions
of manic
5.
Hanson
was
DRR-OPD-GCRC
presented
Neuro
at the
psychiatric
in
and
epi-
1994
Association,
psychiatric
in
1993;
results
43:2099-2104
Diagnostic
and
3rd edition,
revised.
late
Am J
basal
from
gan-
quantita-
Statistical
Washington,
Man-
DC,
1987
Fishman
M, et al: Screening
clinic:
the importance
medical
J Psychiatry
M, Lyketsos
disorders
and
dementia:
Association,
early
virus infection.
McArthur
Neurology
Association:
hit
syndrome
M, et al: Mania
FIIV-1-associated
GJ, Fishman
L, et al: Manic
148:1068-1070
Fishman
Lyketsos
CG, Hanson
AL,
atric disorders in an HIV
Med
1994;
24:103-113
associated
with
HIV
and treat-
infection,
in
8.
Ketonen
immunodeficiency
1993; 150:326-327
EH, Henderer
JD,
chiatric presence.
7.
AE,
1991;
AL,
of human
tive neuroimaging.
American
Psychiatric
6. Treisman
ment of
of
study
of patients
mania
may
improve
of the brain
development
Psychiatry
Aylward
glia volume
hypothe-
dysfunction.
Given
the evolving
understanding
brain
infection
and
the
relatively
predictable
prospective
develop
of the American
ual of Mental
Disorders,
American
Psychiatric
associated
with
a personal
or family
history
of mood
disorder,
indicating
a genetic
condition,
whereas
AIDS
mania
was linked
to cognitive
impairment
and execu-
course
of HIV
disease,
with
HIV infection
who
3.
of AIDS
This
Grant
study
RI.
in the course
We
by NIH
of this
REPORTS
References
2.
AIDS
mania,
is a secondary
the pathophysiology
of HIV
mania may represent bipolar
supported
abstract
RESEARCH
sympand were
hypothe-
mania.
tive
HIV
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