Ellen S R, Judd F K, Mijch A M, Cockram A
Department of Psychiatry, University of Melbourne, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
Aust N Z J Psychiatry. 1999 Jun;33(3):353-60. doi: 10.1046/j.1440-1614.1999.00574.x.
The aim of this study was to identify a cohort of patients with mania secondary to HIV infection, to describe the clinical and radiological features of HIV-related mania, and to describe the treatment outcome of the patients.
All patients referred to the HIV consultation-liaison psychiatry service over the 29-month period from January 1993 to June 1995 were screened for the presence of manic symptoms. Diagnosis of mania was made according to DSM-III-R. Cases were defined as secondary mania if there was no clear history of mood disorder, and no family history of mood disorder. Cases were interviewed by the treating psychiatry registrar and psychiatrist to obtain information regarding present and past psychiatric history and family history of psychiatric disorder. The psychiatry registrar and consultant determined treatment.
Twenty-three patients with mania were identified; 19 were considered to have secondary mania. The prevalence of secondary mania over the 29 months was 1.2% for HIV-positive patients, and 4.3% for those with AIDS. The clinical characteristics and response to treatment appeared to be similar to mania associated with bipolar affective disorder (primary mania). Neuroradiological abnormalities were common, occurring in 10 of the 19 patients, but did not appear to be clinically relevant. Cognitive impairment developed in five of the 15 patients where follow-up was possible.
Mania occurring in advanced HIV disease appears to be more common than expected from epidemiological data regarding bipolar affective disorder. Differentiating secondary from primary mania has implications for the management and prognosis of mania.
本研究旨在确定一组继发于人类免疫缺陷病毒（HIV）感染的躁狂症患者，描述HIV相关躁狂症的临床和放射学特征，并描述患者的治疗结果。
对1993年1月至1995年6月这29个月期间转诊至HIV会诊-联络精神病学服务的所有患者进行躁狂症状筛查。根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）进行躁狂症诊断。如果没有明确的情绪障碍病史且没有情绪障碍家族史，则将病例定义为继发性躁狂症。由主治精神科住院医师和精神科医生对病例进行访谈，以获取有关当前和过去的精神病史以及精神疾病家族史的信息。精神科住院医师和顾问确定治疗方案。
确定了23例躁狂症患者；其中19例被认为患有继发性躁狂症。在这29个月中，HIV阳性患者继发性躁狂症的患病率为1.2%，艾滋病患者为4.3%。其临床特征和对治疗的反应似乎与双相情感障碍相关的躁狂症（原发性躁狂症）相似。神经放射学异常很常见，19例患者中有10例出现，但似乎与临床无关。在15例可以进行随访的患者中，有5例出现了认知障碍。
晚期HIV疾病中出现的躁狂症似乎比双相情感障碍的流行病学数据预期的更为常见。区分继发性躁狂症和原发性躁狂症对躁狂症的管理和预后具有重要意义。
