#Dengue #Psychiatry #Neuropsychiatry
Dengue, often referred to as “seven-day fever”
or “breakbone fever,” is a
mosquito-borne arboviral disease. Prevalent in
tropical and subtropical regions, it poses a major public health challenge due
to its high morbidity and the lack of specific antiviral treatments. While
neurological complications such as encephalitis or myelitis are now well
recognized,
secondary psychiatric disorders remain largely underestimated.
Currently, treatment is
limited to symptom
management, which often neglects the evaluation and follow-up of the
psychological consequences of infection. However, several studies have reported
cases of mood disorders, anxiety, mania, psychosis, and even obsessive or
dysmorphic disorders emerging during or after dengue infection. These
psychiatric symptoms can persist well beyond the acute phase,
significantly
impacting patients' quality of life.
The main challenges are numerous:
absence of
psychiatric screening protocols, lack of awareness among healthcare providers,
confusion with drug side effects (especially corticosteroids), and a lack of
robust longitudinal data. These gaps hinder the understanding of the true
origin of these manifestations and their appropriate management.
The aim of this narrative review is to analyze
all available data on post-dengue psychiatric disorders, to
propose
pathophysiological explanations, identify predictive factors for their
occurrence, and discuss current therapeutic strategies.
Viral fever or psychological shock?
A total of 30 studies were included: 14
observational studies, 14 case reports, and 2 case series. The data were
grouped according to psychiatric disorder types to better understand their
frequency, potential causes, and treatment approaches. Study selection was
based on the PEO framework (Population, Exposure, Outcome).
The most frequently reported psychiatric
symptoms were
depression and anxiety, with prevalence rates ranging from 60% to
81% during the acute dengue phase. Episodes of mania, psychosis, and rare cases
of body dysmorphic disorder were also reported, typically occurring during the
febrile stage or in the weeks following recovery.
From a pathophysiological perspective, several
mechanisms have been proposed to explain these disorders. These include the
activation of pro-inflammatory cytokines,
disturbances in serotonin metabolism,
and
epigenetic changes related to histone deacetylase (HDAC) activation. These
mechanisms are similar to those observed in other flavivirus infections, such
as Zika or West Nile virus.
Predictive factors include
high fever, marked
thrombocytopenia, central nervous system involvement, and infections with
DENV-2 or DENV-3 serotypes. Psychological stress caused by hospitalization or
the perceived severity of illness also appears to play a significant role in
the development of psychiatric complications.
Currently, there are
no specific guidelines for
managing dengue-related psychiatric disorders. Treatments are mostly adapted
from conventional psychiatric practice, including mood stabilizers,
antipsychotics, and anxiolytics. HDAC inhibitors have also been highlighted as
a potential therapeutic avenue, opening up the possibility for more targeted
treatment strategies.
The mind versus the mosquito?
Dengue can cause
long-lasting psychiatric
complications that remain underrecognized in clinical practice. These
mental
health disorders—ranging from anxiety to psychosis—pose a
significant challenge
for healthcare providers due to their diversity, unpredictability, and the lack
of specific screening and treatment guidelines.
This review sought to better define these
disorders, understand their underlying mechanisms, and identify associated risk
factors.
The results confirm that dengue can
trigger or worsen mental health
issues, particularly in severe forms or when neurological complications are
present.
Despite this, current data remain fragmented
and largely based on isolated case reports, limiting the generalizability of
findings. The absence of standardized diagnostic tools and adapted treatment
protocols remains a significant limitation.
Large-scale longitudinal research is needed to
better
understand the progression of these disorders, validate specific
biomarkers, and
explore targeted therapeutic approaches—particularly those
involving inflammatory and epigenetic pathways. A multidisciplinary approach
involving psychiatrists, neurologists, infectious disease specialists, and
researchers is essential to integrate mental health into comprehensive dengue
care. Without such recognition, the invisible burden of the disease risks
remaining in the shadows.
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