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Early-Onset Versus Late-Onset HIV-Related Secondary Mania in Uganda

Received August 5, 2006; revised November 23, 2006; accepted December 4, 2006. From the Departments of Psychiatry, Internal Medicine, and Clinical Epidemiology and Biostatistics, Makerere University Medical School. Send correspondence and reprint requests to Etheldreda Nakimuli-Mpungu, Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health, Baltimore, MD 21205. e-mail: ethelmpungu{at}yahoo.com
© 2008 The Academy of Psychosomatic Medicine

BACKGROUND: First-episode secondary mania in human immunodeficiency virus (HIV) infection has been described among samples of predominantly Caucasian, HIV-positive male patients in developed countries. OBJECTIVE: The goal of this study was to compare the demographic and clinical characteristics of HIV-positive patients with early-onset and late-onset first-episode secondary mania in HIV infection. There were previous findings of an association between late-onset mania and severe cognitive impairment. METHOD: Subjects were HIV inpatients with clinically-confirmed mania, who received standard demographic, psychiatric, physical, and laboratory assessments. Early-onset patients had CD4 cell counts >200 mm³; late-onset patients had CD4 cell counts 200 mm.³ RESULTS: There were no demographic or cognitive differences between early-onset and late-onset mania patients, and high rates of psychotic symptoms in both groups. However, late-onset patients had more manic symptoms. CONCLUSION: Late-onset HIV mania patients had more severe psychopathology and, thus, demonstrated a greater need for highly active retroviral therapy.

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