F06.0; F06.2; F06.31-34; F06.4; F06.8
DESCRIPTION
- HIV infected children and adolescents are at increased risk of psychopathology, such as ADHD, depression and anxiety disorders. Psychosis and mania are less common than in the adult population.
- The increased risk of psychopathology is due to the virus itself, side effects of antiretroviral therapy (ART) and psychosocial stressors.
- Symptom presentation of psychiatric disorders in HIV positive children is the same as in the general paediatric population.
- ADHD often co-occurs with significant learning difficulties, despite treatment with antiretroviral therapy (ART).
- Psychotic disorders are rare in HIV infected children. Consider a delirium or partial seizures if an HIV infected child presents with psychotic symptoms. A full medical workup including CSF and HIV viral load is required before assuming that the symptoms are due to a psychiatric disorder.
GENERAL AND SUPPORTIVE MEASURES
- Psychological interventions are similar to those for HIV negative children.
- Issues specific to the child’s HIV status may need specific intervention e.g. for problems related to disclosure of HIV status, stigma, grief counselling, adherence issues, orphanhood and living with a chronic illness.
- Refer to the hospital social worker to address social issues.
MEDICATION TREATMENT
- Start all medications at lower doses and then titrate up slowly.
- Initiate treatment according to guidance in this chapter.
Note: due to drug-drug interactions between fluoxetine and some antiretroviral medication, initiate treatment with citalopram when an SSRI is required.
REFERRAL
- All HIV infected children on ART who present with severe psychiatric symptoms such as severe depression, psychosis and/or mania for general medical evaluation, and if no general medical cause is found, for psychiatric evaluation and initiation of psychotropic medication.