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 Table of Contents    
LETTER TO EDITOR  
Year : 2019  |  Volume : 61  |  Issue : 1  |  Page : 100-101
Post dengue mania: A case series


Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India

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Date of Web Publication9-Jan-2019
 

How to cite this article:
Krishnan LT, Subramoniam V, Kazhungil F, Tharayil HM. Post dengue mania: A case series. Indian J Psychiatry 2019;61:100-1

How to cite this URL:
Krishnan LT, Subramoniam V, Kazhungil F, Tharayil HM. Post dengue mania: A case series. Indian J Psychiatry [serial online] 2019 [cited 2019 Aug 19];61:100-1. Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/1/100/249661




Sir,

Infective origins of mental illness were hypothesized as early as 1845 by Esquirol. Patients with encephalitis lethargica had features schizophrenia and affective disorders.[1] Although there are reports of encephalitis associated with dengue psychiatric manifestations are under-reported.[2]

During the 2017 dengue outbreak in India, the highest number of dengue cases was reported in Kerala. Here, we report three cases of the first episode of mania following serologically confirmed dengue fever and discuss etiological possibilities of mania following dengue.

Case 1

18-years-old lady, temperamentally easy child with no past or family history of mental illness was brought to psychiatry outpatient department (OPD) after a week of resolution of dengue with decreased sleep, overtalkativeness, easy irritability, over religiosity, and grandiose delusion. She was diagnosed with organic mood disorder mania and improved with olanzapine 15 mg and sodium valproate 1500 mg/day.

Case 2

38-years-old man with no past or family history was brought to OPD. His symptoms started 5 days after resolution of dengue as decreased sleep, increased energy, and over socialization. He had an excessive talk, irritable mood, and expansive ideas. He was diagnosed to have an organic mood disorder mania. He improved within a week on haloperidol 10 mg/day.

Case 3

48-years-old lady with no past or family history was brought 4 days after resolution of dengue fever. She had insomnia, overtalkativeness, over-religiosity, increased psychomotor activity and elated mood. She was diagnosed to have organic mania and improved on olanzapine 5 mg/day in a week.


   Discussion Top


In the cases discussed, there was a temporal relationship between dengue fever and the emergence of mania which aroused suspicion whether a causal relationship existed between dengue and mania.

Dengue virus is a nonneurotropic virus, but in a recent study, the virus could be isolated from brain tissue and cerebrospinal fluid (CSF) of lethal cases of dengue.[3] In our cases, demonstration of dengue virus in CSF would have been confirmatory, but was not undertaken. There was no suspicion of encephalitis rendering this as sensorium was intact. There are reports that dengue encephalopathy may have no CSF changes.[2] No reports of mania following dengue have demonstrated structural changes in the brain.[4],[5]

In our cases, absence of previous affective episodes, family history, and psychosocial stressors strongly supported organic etiology. All the cases recovered rapidly unlike that of typical mania. The homotypical manifestation of cases also suggested organicity. Follow-up of cases looking at course of illness would help to delineate it from an independent mood disorder.

There are a few indicators against organic etiology as well. Dengue outbreak is a traumatic event with thanatophobia and trauma of witnessing death.[6] Hence in the aftermath of outbreak, the possibility of reactive psychosis also needs to be considered. A few argue that dengue and psychiatric disorders are only accidental co-occurrence mentioning Thailand's database where dengue prevalence is the highest.[7]

The case series suggests that research on psychiatric disorders in patients affected with such infective outbreaks may shed light on the infective etiology of psychiatric disorders.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Crow TJ. Viral causes of psychiatric disease. Postgrad Med J 1978;54:763-7.  Back to cited text no. 1
    
2.
Verma R, Sahu R, Holla V. Neurological manifestations of dengue infection: A review. J Neurol Sci 2014;346:26-34.  Back to cited text no. 2
    
3.
Miagostovich MP, Ramos RG, Nicol AF, Nogueira RM, Cuzzi-Maya T, Oliveira AV, et al. Retrospective study on dengue fatal cases. Clin Neuropathol 1997;16:204-8.  Back to cited text no. 3
    
4.
Mendhekar DN, Aggarwal P, Aggarwal A. Classical mania associated with dengue infection. Indian J Med Sci 2006;60:115-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Srivastava S, Bhatia MS, Jhanjee A. Organic mania in dengue. J Clin Diagn Res 2013;7:566-7.  Back to cited text no. 5
    
6.
Jhanjee A, Bhatia MS, Srivastava S, Anubhav R. A study of psychiatric symptomatology in dengue patients. Delhi Psychiatry J 2013;16:21-3.  Back to cited text no. 6
    
7.
Wiwanitkit S, Wiwanitkit V. Psychological manifestation in dengue: Did it really exist? Indian J Psychol Med 2013;35:222.  Back to cited text no. 7
[PUBMED]  [Full text]  

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Correspondence Address:
Dr. Firoz Kazhungil
Department of Psychiatry, Government Medical College, Kozhikode, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_311_18

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