Acute Psychosis in a Child with Severe Dengue

Abstract

Dengue fever is emerging as an important cause of acute febrile illness with neuropsychiatric symptoms in adult population especially in endemic areas. Numerous case reports and review articles have already been published in past emphasizing on neurological manifestations in dengue but sufficient data on psychiatric symptoms in paediatric age group is still lacking. Acute psychosis in recovery phase of severe dengue is an uncommon phenomenon, thus rarely reported.

Acute Psychosis and Mania: An Uncommon Complication of Dengue Fever

“…Antipsychotics, benzodiazepines, or mood stabilizers treat dengue mania [14][15][16]. Oral antipsychotics at modest dosages worked well for psychotic presentations [17][18][19][20][21]. Intravenous lorazepam (4 mg/day), tapered and terminated over four weeks, helped catatonic patients [22].…”

Dengue and Psychiatry: Manifestations, Mechanisms, and Management Options

“…36,39 But, the analysis was considered normal in the other two reports. 27,42 Brain imaging studies such as computed tomography [25][26][27]34,35,41 and magnetic resonance imaging 32,33,36,38 in most reports were normal. Metabolic derangements, including elevated liver enzymes, 24,25 electrolyte abnormalities, 27 vasculitis with capillary leak, and fluid extravasations, were postulated.…”

“…At 6-24 months' follow-up after dengue infection, the rates of depression were 15%. 20 There are multiple case reports of manic presentation, [24][25][26][27][28][29][30][31] acute polymorphic psychosis, [32][33][34][35][36][37][38][39] prolonged depression, 40 and catatonia 29,41 and one on rapid cognitive decline. 42 However, the evidence for a psychotic, manic, or catatonic presentation from observational studies is lacking.…”

“…24,[26][27][28][29] For psychotic presentations, a good response was achieved with oral antipsychotic agents, mostly in low doses. [32][33][34][35][36][37]39 Catatonic presentation responded well to intravenous lorazepam 4 mg/day, which was tapered and stopped over four weeks. 41 It was noted that clonazepam and lowdose quetiapine were started for dengue patients with psychiatric comorbidity without an appropriate specialist referral.…”