GuidelinesPEML (Paeds Hospital STG)
Psychiatric Presentations in HIV Infected Children and Adolescents
Psychiatric Presentations in HIV Infected Children and Adolescent
General and supportive measures
ICD-10 codes: 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.
- 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.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 14: Child & Adolescent Psychiatry, 14.11 Psychiatric Presentations in HIV-Infected Children And Adolescents