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close this bookNational Guidelines for the Clinical Management of HIV/AIDS - Tanzania (NACP; 2005; 131 pages)
View the documentLIST OF ABBREVIATIONS
View the documentACKNOWLEDGEMENTS
View the documentFOREWORD
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: ORGANIZATION OF HIV/AIDS CARE AND TREATMENT
Open this folder and view contentsCHAPTER 3: HIV/AIDS PREVENTION
Open this folder and view contentsCHAPTER 4: PROTECTIVE MEASURES AGAINST HIV TRANSMISSION
Open this folder and view contentsCHAPTER 5: LABORATORY TESTS IN HIV/AIDS
Open this folder and view contentsCHAPTER 6: HIV/AIDS AND PREGNANCY
Open this folder and view contentsCHAPTER 7: PEDIATRIC HIV/AIDS AND RELATED CONDITIONS
Open this folder and view contentsCHAPTER 8: COMMUNITY AND HOME BASED CARE FOR PEOPLE LIVING WITH HIV/AIDS (PLHA)
Open this folder and view contentsCHAPTER 9: COUNSELLING RELATED TO HIV-TESTING AND TREATMENT ADHERENCE
Open this folder and view contentsCHAPTER 10: MANAGEMENT OF COMMON SYMPTOMS AND OPPORTUNISTIC INFECTIONS IN HIV/AIDS
close this folderCHAPTER 11: MANAGEMENT OF MENTAL HEALTH PROBLEMS IN HIV/AIDS
View the document11.1 Neurological complications with secondary mental manifestations
View the document11.2 Changes in mental status - Delirium (acute organic brain syndrome)
View the document11.3 Changes in mental status - AIDS related dementia (ADC) (chronic organic brain syndrome)
View the document11.4 Changes in mental status - AIDS Related Mania
Open this folder and view contents11.5 Mental complications
View the document11.6 Crisis and crisis counseling
View the document11.7 Persons with previous mental disorders
Open this folder and view contentsCHAPTER 12: MANAGEMENT OF HIV INFECTED PATIENTS USING ANTIRETROVIRAL DRUGS
Open this folder and view contentsCHAPTER 13: ARV THERAPY IN INFANTS AND CHILDREN
Open this folder and view contentsCHAPTER 14: USE OF ARVS IN SPECIAL CIRCUMSTANCES
Open this folder and view contentsCHAPTER 15: HIV/AIDS AND NUTRITION
Open this folder and view contentsCHAPTER 16: MANAGEMENT OF ANTIRETROVIRAL MEDICINES
Open this folder and view contentsCHAPTER 17: CERTIFICATION OF HEALTHCARE FACILITIES AS CARE AND TREATMENT SITES
 

11.2 Changes in mental status - Delirium (acute organic brain syndrome)

Delirium is a condition where acute changes in global brain functioning occurs. Delirium can occur in patients with focal brain lesions as well as meningitis. The behavioral manifestations of delirium can be misdiagnosed as a functional psychosis and delay recognition of an underlying treatable organic brain disease. It is important to recognize delirium, as it is often an early manifestation of the conditions mentioned in 1.1 and 1.2 above and often precedes the more severe disturbance of consciousness - coma.

The central features of delirium that distinguishes it from acute functional psychoses include impairment in orientation and memory (test for registration and immediate recall) that manifests as poor recall of recent events, misidentification of people, fear and loosely held persecutory ideas. It is important to formally assess orientation and memory, rather than depend on just observations of the patients behavior as changes in behavior are often seen in both patients with functional and organic brain syndromes and are not sufficiently specific for either condition to allow for distinguishing one from the other.

• Less sedating major tranquilizers such as Haloperidol should be used at low doses (3-9 mg daily, titrate dose to response making changes in drug dose after one hour of observation of effects if acutely agitated on day of initiation of parenteral treatment and at least after 3 days of observation of effects if on oral medication) to control these symptoms, while treating underlying causes of organic brain disease. The choice of Haloperidol is also because it does not lower the seizure threshold and thus does not predispose patients who are already vulnerable to developing seizures to have them.

• Assess after patient calm - usually after one week of treatment, to rule out underlying depression, mixed depression and anxiety or anxiety disorder and treat accordingly.

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