Faculty Bibliography

HIV infection and sarcoidosis occur in the same age group, but there are only a few reports of the coexistence of the two disorders in the same individual. This infrequent occurrence has been attributed to the paucity of functioning CD4(+) lymphocytes required for granuloma formation in patients with HIV infection. We report two patients with a history of remote sarcoidosis who later in life contracted HIV infection and developed recurrent, progressive pulmonary sarcoidosis while receiving highly active antiretroviral therapy (HAART). Progressive pulmonary sarcoidosis should be added to the differential diagnosis in patients receiving HAART for HIV infection who develop diffuse lung disease with recovery of CD4(+) lymphocyte population

A chart review of 658 psychiatric inpatients aged 65 years or older with a clinical diagnosis of schizophrenia revealed 32 patients (4.8%) with onset of symptoms after aged 45 who met DSM-III criteria for schizophrenia (except age of onset). Clinical course and response to treatment revealed only 25% to follow an unequivocally schizophrenic pattern. Almost 20% demonstrated substantial affective symptomatology, whereas 15.6% had a brief psychotic episode with full remission, and 40.6% showed signs of organic deterioration. These results suggest that diverse underlying pathologic processes may present initially as late onset schizophreniform illness. The presence of depressive symptoms and assaultive behavior on admission predicted good treatment response while sensory deficits and development of signs of organicity were associated with poor treatment response

Ratings of mood and affect using the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression, the Center for Epidemiologic Studies Depression Scale (CES-D), and an affective flattening scale in 32 male schizophrenic inpatients revealed high total scale reliability but lower intra-item reliability, especially for specific depression items. Interscale correlations suggested several dimensions of mood and affect: anxiety-depression (psychological dysphoria, motor activation, and somatic symptoms), retardation-affective blunting, thought disturbance, and hostility-suspiciousness. Correlation with a rating of extrapyramidal symptoms suggested an association with the presence of depressive symptoms. These results suggest that although adequate total scale reliability was obtained, these indexes of depression may measure different dimensions in schizophrenic patients than they do in patients with affective disorders