Psychiatric manifestations of HIV disease JOSE CATALAN Human immunodeficiency virus (HIV) disease, like other serious and potentially fatal disorders (Derogatis, 1985), has important psychosocial and neuropsychiatric implications. Such psychological impact is understand- able, as in addition to its unpredictable course, distressing manifestations and sombre outcome, HIV disease usually affects young adults, making the process of coping with the illness even more harrowing. In addition, individuals who develop HIV infection in Western countries tend to belong to social groups who have experienced social rejection and psychological difficulties (gay men or drug users) or chronic ill health (men with haemo- philia) prior to the disease, and who may be predisposed to further problems. Finally, the fears and social rejection which HIV disease and those affected by it evoke often complicate an already distressing situation. HIV infection can also cause a variety of acute and chronic neuropsychiatric disorders, resulting from the direct effects of the virus or’secondary to opportunistic infections or tumours. The psychological problems seen in HIVdisease, added to the complexities of treating a disorder affecting multiple organs and systems, presents medical and nursing teams with a heavy burden of care and with difficult clinical decisions which can lead to stress, demoralization, job dissatisfaction and loss of efficacy. Here an overview of the psychosocial and neuropsychiatric problems likely to develop in people with HIV disease will be given, followed by discussion of ways in which these problems can be tackled by the medical team, paramedical staff and by specialist mental health care workers. PSYCHIATRIC PROBLEMS IN HIV DISEASE As shown by clinical and research experience in general hospitals, there is an association between physical and psychiatric disorders: physical disease can cause psychologically understandable reactions to the disease, and it can also cause organic brain syndromes with significant behavioural mani- festations; psychological and behavioural factors can contribute to physical disorders; psychiatric disorders may present with physical symptoms; finally, both types of disorder can appear together by chance (Gelder et al, 1989). All these possibilities can occur in HIV disease. Baillidre’s Clinical Gastroenterology- 547 Vol. 4, No. 2, June 1990 Copyright 0 1990, by Baillitre Tindall ISBN o-7020-1469-9 All rights of reproduction in any form reserved