The Specialist Forum Volume 13 No 11 November 2013 | Page 17

HIV/AIDS

Bipolar disorder
Bipolar disorder is characterised by one or more manic or hypomanic
episodes with or without depression.
First-line mood stabilisers (valporate) are recommended, but should
be peceded by asratate aminotransferance/alanine aminotransferase

and platelet tests.
In addition, it is very important to monitor liver function and to adjust
the dose accordingly, advise the authors.
Lithium should be avoided in dehydrated patients and those with
renal function impairment.

DoH treatment algorithm
The new DoH algorithm is divided into patients with a recent onset of changing levels of consciousness who experience delirium and those who don’t.
The word delirium is derived from the Latin term meaning ‘off the
track’. Delirium is defined as a ‘transient, usually reversible, cause
of cerebral dysfunction’. While it can manifest with a wide range of
neuropsychological abnormalities, it is most often characterised by
decreased attention span and a waxing and waning type of confusion.
The syndrome is also sometimes referred to as an ‘acute confusional
state’, explains psychiatrist, Dr Ian Westmore.

Management of patients with and without delirium
With delirium
According to the DoH, patients with the following symptoms need urgent
attention:
• Disturbance of consciousness (reduced clarity of awareness of the
environment) with reduced ability to focus, sustain, or shift attention.
• Change in cognition (memory deficit, disorientation, language disturbance, perceptual disturbance) that is not better accounted for by a
pre-existing, established, or evolving dementia.
• The disturbance develops over a short period (usually hours to days)
and tends to fluctuate during the course of the day.
• There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by a direct physiologic

consequence of a general medical condition, an intoxicating substance, medication use, or more than one cause.
An accurate diagnosis and identification or underlying organic pathology is particularly important in treating delirium. In some cases, where
patients pose a risk to themselves (those who become combative or are
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