D'Souza Priyanka Renita, D'Silva Debora Sona
Department of Psychiatry, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India.
Department of Medicine, Father Muller Medical College, Mangalore, Karnataka, India.
J Trop Med. 2025 May 25;2025:7136558. doi: 10.1155/jotm/7136558. eCollection 2025.
Dengue is one of the major public health concerns in tropical and subtropical countries. In addition to neurological sequelae which are well documented, emerging evidence suggests that dengue may also lead to psychiatric sequelae including mood disorders, psychosis, anxiety, and body dysmorphic disorder. This narrative review aims to synthesize the existing literature to explore the psychiatric manifestations and postulated pathophysiological mechanisms and identify predictors and treatment of psychiatric sequelae in dengue. This review identified 30 studies including observational studies, case reports, and case series. The immune-inflammatory responses due to cytokine dysregulation, blood-brain barrier disruption, direct viral effects, and epigenetic mechanisms with histone deacetylase activation are possible contributors to psychiatric sequelae in dengue. The main predictors include severity of dengue, thrombocytopenia, central nervous system involvement, febrile and critical phase of illness, specific dengue virus serotypes (DENV-2 and DENV-3), and stress due to hospitalization. Psychiatric symptoms often persist beyond the acute phase, highlighting the importance of long-term follow-up to evaluate the impact of dengue on mental health. Additionally, comparisons with other Flaviviridae viruses, such as Zika, West Nile, and Japanese encephalitis viruses, reveal both shared and distinct psychiatric implications, suggesting potential virus-specific mechanisms. The current treatment approaches are largely extrapolated from general psychiatric practice, with limited research on targeted interventions. Future research should focus on standardized diagnostic assessment, longitudinal follow-up, diagnostic biomarkers, and developing targeted treatment strategies to improve clinical outcomes. With rising cases of dengue, integrating psychiatric screening into routine dengue management may enhance early recognition and intervention. Hence, a multidisciplinary research approach involving psychiatrists, neurologists, infectious disease specialists, immunologists, and policymakers is crucial for addressing psychiatric sequelae in dengue fever and mitigating the detrimental implications on public health.
登革热是热带和亚热带国家主要的公共卫生问题之一。除了有充分记录的神经后遗症外，新出现的证据表明，登革热还可能导致精神后遗症，包括情绪障碍、精神病、焦虑症和躯体变形障碍。本叙述性综述旨在综合现有文献，探讨精神症状表现和假定的病理生理机制，并确定登革热精神后遗症的预测因素和治疗方法。该综述纳入了30项研究，包括观察性研究、病例报告和病例系列。细胞因子失调、血脑屏障破坏、病毒直接作用以及组蛋白去乙酰化酶激活导致的表观遗传机制所引发的免疫炎症反应，可能是登革热精神后遗症的成因。主要预测因素包括登革热的严重程度、血小板减少、中枢神经系统受累、疾病的发热期和危重症期、特定的登革热病毒血清型（DENV-2和DENV-3）以及住院带来的压力。精神症状往往在急性期过后仍持续存在，这凸显了长期随访以评估登革热对心理健康影响的重要性。此外，与其他黄病毒科病毒（如寨卡病毒、西尼罗河病毒和日本脑炎病毒）的比较揭示了共同和独特的精神影响，提示可能存在病毒特异性机制。目前的治疗方法大多是从一般精神科实践中推断而来，针对干预措施的研究有限。未来的研究应聚焦于标准化诊断评估、纵向随访、诊断生物标志物以及制定针对性治疗策略以改善临床结局。随着登革热病例的增加，将精神科筛查纳入常规登革热管理可能会提高早期识别和干预能力。因此，涉及精神科医生、神经科医生、传染病专家、免疫学家和政策制定者的多学科研究方法对于解决登革热精神后遗症及减轻对公共卫生的有害影响至关重要。
