HIV-related psychosis

A 35-year-old Ugandan man was escorted to the emergency department by his family following 2 days of uncharacteristic behaviour. He had presented himself to a police station believing that he was guilty of terrorist acts. He had no psychiatric history and no history of illicit drug use. The patient was responding to auditory hallucinations and lacked insight into his symptoms. Preliminary blood investigations and a computed tomography brain scan were normal. The patient was able to give informed consent for an HIV test, which was positive. He was admitted to a psychiatric ward and was successfully treated with antipsychotic medication.