Aksoy F, Goncu H, Uguz F
Varicella zoster -induced psychosis: a case report
Although chickenpox, caused by Varicella Zoster Virus (VZV), may occur at any time during the lifetime of humans, more than 90 % of people experience this infection before their adolescence. Although there are some reports about the relationship between herpes family of which VZV is a member, and psychiatric symptoms, these mostly include psychiatric complications secondary to encephalitis resulting from these infections. In this report, we present a patient with schizophrenia that occurred after VZV infection without any central nervous system complication. A 21-year-old male was admitted to the Psychiatric Outpatient of a University Hospital with the support of his family. The main complaints of the patient were feeling different in his own body, anxiety, and insomnia. The patient believed that he had a carcinoma. In addition, his family described the patient having persecution and reference delusions, irritability, aggressive behavior, increases in speech and social isolation. The patient had no individual or family history of any psychiatric disorder. These psychiatric symptoms were manifested in the previous one-week. The patient and his family reported that, VZV infection was diagnosed in this patient by a specialist of infectious diseases two weeks previous and the psychiatric symptoms developed following this infection. At the time of admission, the patient was not taking any medication. Psychiatric examinations suggested that the patient had normal consciousness and orientation types. The pathological psychiatric findings were disorganized speech, somatic, persecution and reference delusions, irritability, psychomotor agitation, depersonalization and dysphoric affect. Moreover, the patient had no insight about this disorder. The patient was consulted with the Departments of Neurology and Infectious Diseases for differential diagnosis. The physical and neurological examination results as well as the routine hemogram and biochemical laboratory tests’ results were normal. Observations of lumbar puncture, EEG (electroencephalography) and brain MRI (magnetic resonance image) were also normal. Consequently, no organic pathology could be established at these consultations. Psychiatric interview by means of SCID-1 showed a diagnosis of acute psychotic disorder. The patient was started with olanzapine at 10 mg/day. One month later, the symptoms of delusions, speech disturbances and depersonalization were completely resolved. However, the symptoms of social isolation were minimally decreased and the patient still had a blunted affect. Six months later there were continuing residual symptoms such as social isolation and blunted affect. After the last examination the diagnosis of the patient was changed to schizophrenia. During the follow up period no neurological complications or symptoms were observed. Schizophrenia is a relatively common neuropsychiatric disease, in which the etiology is unclear. Epidemiologic studies have shown that environmental factors such as infections might be associated with increased risk of schizophrenia. Some authors have reported the relationship between schizophrenia and toxoplasma, cytomegalovirus, herpes simplex virus, human herpes virus-6, inşuenza, coronavirus and Epstein-Barr virus infections. This case report suggests that VZV infection in adulthood might trigger schizophrenic symptoms in some individuals. Further large-scale studies should examine the incidence and clinical course of schizophrenia or psychotic disorders following VZV infections in adults.