人類免疫缺乏病毒感染合併精神症狀：一個案報告

一、目的：強調一老人經由性交感染愛滋病後有明顯正性的精神症狀，是人類免疫缺乏病毒感染合併腦病變(HIV-associated encephalopathy)較嚴重的合併症之一，但臨床並不常見。二、個案報告：一73歲男性被其鄰居朋友發現漸有明顯之精神症狀，如自言自語、被害妄想、聽幻覺，但均未就醫。約在住院前數天，開始合併出現有焦慮、不眠、激躁不安、語無倫次、視幻覺等嚴重干擾鄰居安寧之情況，而被其朋友鄰居送至醫院就醫並住於精神科病房，住院期間，理學檢查及精神檢查發現病人有發燒、皮膚紅疹及正性精神症狀，仍然明顯；且以抗精神病藥物控制（主要治療藥物爲risperdal）。實驗室及胸部X光檢查發現有：白血球和C-反應性蛋白過高，右肺葉浸潤，以及anti-HIV抗體陽性等。三、討論： 1．在愛滋病或愛滋病相關複合症(AIDS-related complex，ARC)或更早期的病人中，將近有一半或以上的病患有腦病變的現象，病患可能呈現出痴呆、精神錯亂或性格改變的狀況，但出現精神症狀也可能由於心理的原因引起之焦慮、憂鬱或內分泌異常、代謝不良、營養缺乏、藥物、腫瘤或伺機性感染而引起。 2．近幾年在性開放及HIV快速蔓延的情況之下，即使是上年紀的老年人，若有懷疑到器質性原因引起之精神症狀，仍需將HIV牢記於心，以爲早期發現、早期治療。

關鍵字

愛滋病；精神症狀；失智症

並列摘要

Objective: Psychosis is unusual among the severe complication in the patient with HIV associated encephalopathy. A case of psychosis in HIV transmitted by sexual behavior is reported. Case Report: A 73 year-old male with gradually increased prominent psychotic symptoms including self-talking, persecutory delusion and auditory hallucination was noticed by his friend. A few days later, his psychosis worsened with prominent anxiety, insomnia, irritability, incoherence, visual hallucination and disturbing behavior. He was then brought to our hospital and admitted into the psychiatric ward. Upon admission, the patient was noticed with fever, skin rash and prominent. Laboratory results showed increased white blood cell count, CRP and anti-HIV antibody. Chest x-ray showed infiltration over right lung field. Discussion: 1. Over 50% of the HIV positive patients or patients with AIDS-related complex have encephalopathy in the early stage. These patients may present dementia、psychotic or personality change. However, other possible causes for psychotic symptoms including psychological factors、endocrine problems、abnormal metabolism、malnutrition、drug、tumor or infection should be ruled out. 2. In recent years, due to the quick spread of HIV through sexual behaviors, when elderly people are noticed with prominent psychotic symptoms, we should consider HIV infection as an organic factors as well in the hope of early treatment.