Neuropsychiatric Aspects of HIV Infection.

Abstract

1 younger adults and be increased gradually to minimize side effects and identify low-dose responses.Although few data are available from well-controlled clinical trials, these findings and clinical experience indicate that most psychotropic drugs used for younger adults are also effective in elderly patients.The choice of a particular medi- cation depends on its side effects, given the similar efficacy within psychotropic drug classes.A low dosage of a high- potency neuroleptic drug, such as 0.5 mg to 2 mg of haloper- idol in 24 hours, may lessen agitation and psychosis and have minor anticholinergic and cardiovascular effects.A clinician should reassess efficacy over time, however, because aka- thisia or motor restlessness develops in many patients, which is sometimes confused with the underlying agitation.Clin- ical trials indicate that antidepressant response rates for geri- atric depression range from 30% to 80%.Tertiary amine tricyclic antidepressants, such as doxepin hydrochloride starting at a dose of 25 mg, appear to help agitated depres- sions; secondary amine agents, such as nortryptiline hydro- chloride, tend to decrease retarded depressions.Benzodiaze- pines are useful in treating insomnia (for instance, temazepam, 15 mg an hour before bedtime) or daytime anx- iety (lorazepam in 0.5-mg increments).Benzodiazepines with long half-lives tend to accumulate in the blood, are more likely to cause side effects, and their use should be avoided.Nonpharmacologic measures should always be attempted before using medications and often complement pharmaco- logic approaches.Psychotherapy is effective for many forms of geriatric depression.Anecdotal reports suggest that in- somnia sometimes abates with such simple remedies as elim- inating daytime napping and taking hot milk and tryptophan, 0.5 to 1 gram, at bedtime, although definitive data from controlled studies are lacking.