Psicose secundária ao HIV versus esquizofrenia

HIV-associated psychosis and Schizophrenia are two pathologies which have some characteristics in common. This article intents to clarify the differential diagnosis between these two clinical entities, exposing a clinical case with a male patient, 31 years old, HIV positive for 7 years, with poor adherence to treatment, without psychiatric antecedents, a regular cannabis user who is conducted to our psychiatric emergency with psychiatric alterations (persecutory delusion, delusion of grandeur, auditory and visual hallucinations) and behavioral alterations (physical and verbal heteroagressivity). The patient was admitted in our psychiatric department. During his admission a multidisciplinary assessment was needed, with participation of Infectiology, Neuroradiology and Neurology, the patient was submitted to an exhaustive evaluation with lymphocyte population counts, HIV viral load, ceruloplasmin levels, hemochromatosis tests, magnetic resonance imaging (MRI), cerebrospinal fluid analysis and, finally, neuropsychological testing, which documented severe alterations in sustained attention and moderate alterations in executive functions. The MRI findings were compatible to HIV Encephalopathy, which is a clinical entity characterized by a triad of behavioral, cognitive and motor dysfunctions that normally occurs in advanced stages of HIV infection. This clinical case raised some doubts about HIV Encephalopathy diagnosis not only because the patient didn’t present motor dysfunctions, only those caused by medication, but also, because of the poor response to the antipsychotic medication, not usually found in patients with psychosis and HIV.