Development of acute psychotic disorders and HIV-1 infection

Int J Psychiatry Med. 2000;30(2):173-83. doi: 10.2190/PLGX-N48F-RBHJ-UF8K.


Objective: To gain more understanding about the relationship between human immunodeficiency virus type 1 (HIV-1) infection and new-onset psychosis, we compared clinical and immunological findings, psychiatric symptoms, global cognitive performance and, when available, computerized tomography (CT) findings between HIV-1-seropositive patients with new-onset psychosis and well-matched nonpsychotic HIV-1-seropositives.

Methods: Two groups of subjects: HIV-1-seropositives with new-onset psychosis (n = 12) and HIV-1-seropositives without psychosis (n = 15) were recruited through outpatient departments. Organic Delusional Syndrome and Organic Hallucinosis were clinically diagnosed using DSM-III-R diagnostic criteria. Of the baseline participants, twenty-two participated in the two-year follow-up examination.

Results: The prevalence of new-onset psychosis in HIV-1-infected subjects was 3.7 per 100 (95% C.I. = 1.6-5.7). HIV-1-seropositive persons with new-onset psychosis had more frequently a positive past psychiatric history, no antiretroviral therapy, and a lower global cognitive performance than did the nonpsychotic HIV-1-seropositives. CT was positive, showing generalized brain atrophy, in three out of nine patients. Remission of psychotic symptoms was observed only in two HIV-1-seropositive persons with new-onset psychosis. Death occurred in two psychic HIV-1-seropositives with simple loosely held delusions. Autopsy results showed that cortical sulci and ventricle size were graded as with moderate/severe enlargement.

Conclusions: New-onset psychosis in HIV infected patients could raise considerable problems in deciding whether a presentation is organic or functional. An interaction of the disease or of psychologically "having" the disease with the presence of a psychotic reaction should also be considered. Interestingly, a protective effect of antiretroviral therapy for new-onset psychosis is suggested.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Dementia Complex / diagnosis
  • AIDS-Related Opportunistic Infections / diagnosis
  • Acute Disease
  • Adult
  • Antiviral Agents / therapeutic use*
  • Brain / pathology*
  • Brain / virology
  • Case-Control Studies
  • Diagnosis, Differential
  • Female
  • HIV Infections / complications*
  • HIV Infections / physiopathology
  • HIV Infections / psychology*
  • HIV Protease Inhibitors / therapeutic use*
  • HIV-1 / isolation & purification
  • Humans
  • Male
  • Neurocognitive Disorders / diagnosis
  • Neurocognitive Disorders / virology
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / pathology
  • Psychotic Disorders / virology*
  • Survival Analysis
  • Treatment Outcome


  • Antiviral Agents
  • HIV Protease Inhibitors