Unusual ego-defence in HIV encephalopathy: A case report

Emotion focused coping strategies, such as denial and escape-avoidance techniques, might have short-term benefits for patients with chronic illnesses (including those with Human Immunodeficiency Virus), however it is associated with increased psychological distress and depressive symptomology in the long-term. The authors present the case of a 34 year old man, who is HIV-positive and presented with auditory and visual hallucinations, persecutory delusions, somatic passivity, cognitive deficits and executive dysfunction. It is argued that in addition to the demonstrated psychotic symptoms and cognitive deficits, there were unusual responses on mental state examination, which had an ego-defensive function, i.e. the inability to function in his usual manner was perceived by the patient as ego-threatening. This case study illustrates some important aspects of disease progression in HIV/AIDS and its neuropsychiatric complications, as well as interesting psychophenomenology. The authors conclude that although the mental state signs appear unusual and worthy of mention, the underlying psychodynamic processes involved seem to be that of emotion focused coping strategies, which are employed subconsciously as a defence mechanism in order to preserve the patient’s own ego-integrity.