Atkinson J H, Grant I
Psychiatry Service, San Diego Veterans Affairs Medical Center, California.
Psychiatr Clin North Am. 1994 Mar;17(1):17-33.
The neuropsychiatric manifestations of HIV disease include neurobiologic and psychobiologic phenomena. The former consist of primary CNS complications caused directly by HIV, and include cognitive disorders (mild neurocognitive disorder and HIV-associated dementia) and other CNS diseases such as myelopathy and the demyelinating neuropathies; and secondary disorders (principally deliria) occasioned by opportunistic infections, neoplasms, cerebrovascular events, and the effects of metabolic derangements and medications. The latter (psychobiologic) phenomena reflect efforts to cope with various nodal, or transition points, in HIV disease; such points of transition include time of serostatus determination, adaptation to asymptomatic seropositivity, response to early medical symptomatology, and later transition to frank AIDS. Anxiety symptoms and various efforts to cope with anxiety (e.g., denial, anger, withdrawal, hypochondriacal preoccupation) all can punctuate these transition points. Additionally, there may be reactivation of long-standing psychopathology (e.g., depression) in seropositive individuals who tend to belong to a group that has an elevated prevalence of pre-infection psychiatric disorder. These interacting neurobiologic and psychobiologic phenomena pose challenges to the psychiatrist who must develop a good understanding of the medical aspects of HIV infection, as well as the neuropsychiatry of AIDS. In this way psychiatric physicians can play an important role in early identification of neuropsychiatric complications, assist the medical team to anticipate emotional and behavioral disturbances, and develop treatment plans that maximize our ability to help those with HIV infection achieve the best possible quality of life.
HIV疾病的神经精神表现包括神经生物学和心理生物学现象。前者由HIV直接引起的原发性中枢神经系统并发症组成，包括认知障碍（轻度神经认知障碍和HIV相关痴呆）以及其他中枢神经系统疾病，如脊髓病和脱髓鞘性神经病；还有由机会性感染、肿瘤、脑血管事件以及代谢紊乱和药物作用引起的继发性疾病（主要是谵妄）。后者（心理生物学）现象反映了在HIV疾病中应对各种节点或过渡点的努力；这些过渡点包括血清学状态确定的时间、适应无症状血清阳性、对早期医学症状的反应以及后来向明显艾滋病的转变。焦虑症状以及应对焦虑的各种努力（如否认、愤怒、退缩、疑病性先占观念）都可能出现在这些过渡点上。此外，在血清阳性个体中，可能会重新激活长期存在的精神病理学问题（如抑郁症），这些个体往往属于感染前精神障碍患病率较高的群体。这些相互作用的神经生物学和心理生物学现象给精神科医生带来了挑战，他们必须很好地理解HIV感染的医学方面以及艾滋病的神经精神病学。通过这种方式，精神科医生可以在早期识别神经精神并发症方面发挥重要作用，协助医疗团队预测情绪和行为障碍，并制定治疗计划，以最大限度地提高我们帮助HIV感染者实现最佳生活质量的能力。
