[Kleine-Levin syndrome. The provocation of manic symptoms by an antidepressant and a therapeutic trial of carbamazepine].

Dtsch Med Wochenschr. 1989 Oct 6;114(40):1528-31.
[Article in German]


Neurologische Klinik, Universität Düsseldorf.


A 17-year-old adolescent had a recurrent episode of somnolence and morbid hunger (Kleine-Levin syndrome) three years after a first attack, from which he had spontaneously recovered. He was treated with 50 mg daily of clomipramine for the somnolence accompanied by disturbance of attention and memory. Under this treatment he developed thymoleptic symptoms with polyphagia, logorrhea and hyperactivity. Placed on a trial dose of at first 600 mg, then 400 mg carbamazepine daily the abnormal findings disappeared within a few days, and there has been no recurrence after some months. It is postulated, based on the observations of this case, that the Kleine-Levin syndrome, presumably a functional hypothalamic disorder, is closely related to the endogenous psychoses.

[PubMed – indexed for MEDLINE]

Uploaded by on Jul 14, 2011

British teenager suffers from a rare syndrome that causes her to sleep for days. A bout of influenza brought on the manic episodes.

Lithium Carbonate is being used to treat the condition.  The medication Lithium is know to induced Creutzfeldt-Jakob syndrome, another encephalopic condition that is fatal.


Mental disorders in influenza.

Mental disorders in influenza.

Tselibeev, B. A.; Brusilovskaya, M. I.
Zhurnal Nevropatologii i Psikhiatrii,  Vol 68(3), 1968, 425-431.


Based on the literature and personal observations during epidemics, the nonpsychotic psychopathological syndromes encountered during the prodromal and febrile periods of influenza, and convalescence were studied. The role of the sympathetic nervous system in these syndromes is stressed. In cases of protracted convalescence with depressive or pseudoneurasthenic disturbances, small doses of ACTH or prednizolon are recommended. Also reported on are 78 cases (16-72 yr. old Ss) of influenza psychoses with prevailing syndromes of an amentive and affective (manic and depressive) nature. Short-term insulin therapy is beneficial in the treatment of influenza psychoses. (PsycINFO Database Record (c) 2012 APA, all rights reserved)




Psychic disturbances associated with influenza are first mentioned in the literature in connection with an epidemic of 1385 in Germany.1 The “deliria” of the epidemic of 1387 are mentioned in accounts2 by Valescus de Taranta and Gassar. The “vexatious deliria” of the epidemic of 1510 are mentioned by Mezèray.3 In “Annals of Influenza,”4 published in 1852, Riverius5 is quoted regarding the epidemic of 1580 thus: “It began with a fever and cough, then followed again a pain of the head and loins, then the fever intermitted a few days and returned with fresh vigor. Some had no rest, but the heat increasing they died; as some did of a phrenzy (!) and others of a consumption.” Henisch the First spoke of the extreme prostration, “somnolent states, lipothymias, and other disquieting incidents” of this same epidemic. Quoted by Espagnol,6 Ozanam7 recounts the occurrence of “such

The neuropsychiatric aspects of influenza/swine flu: A selective review

Year : 2011  |  Volume           : 20             |  Issue : 2  |  Page : 83-90       

The neuropsychiatric aspects of influenza/swine flu: A selective review



The world witnessed the influenza virus during the seasonal epidemics and pandemics. The current strain of H1N1 (swine flu) pandemic is believed to be the legacy of the influenza pandemic (1918-19). The influenza virus has been implicated in many neuropsychiatric disorders. In view of the recent pandemic, it would be interesting to review the neuropsychiatric aspects of influenza, specifically swine flu. Author used popular search engine ‘PUBMED’ to search for published articles with different MeSH terms using Boolean operator (AND). Among these, a selective review of the published literature was done. Acute manifestations of swine flu varied from behavioral changes, fear of misdiagnosis during outbreak, neurological features like seizures, encephalopathy, encephalitis, transverse myelitis, aseptic meningitis, multiple sclerosis, and Guillian-Barre Syndrome. Among the chronic manifestations, schizophrenia, Parkinson’s disease, mood disorder, dementia, and mental retardation have been hypothesized. Further research is required to understand the etiological hypothesis of the chronic manifestations of influenza. The author urges neuroscientists around the world to make use of the current swine flu pandemic as an opportunity for further research.



The literature on the mental diseases associated with influenza is remarkable for its paucity and the inadequacy of the communications, and this well applies to toxic psychoses in general. Bonhoeffer,2 considered authoritative on the subject, ascribed this in a measure to the fact that “for the most part communications concerning the psychoses accompanying or following infectious disease proceed from the pens of others than psychiatrists…. A practical knowledge of the frequency and nature of the

Influenza and mania: a possible connection with the locus ceruleus.

South Med J. 1985 Feb;78(2):207-9.


I have presented a possible case of mania induced by influenza B. Some epidemic influenza viruses may be neurovirulent. These epidemics seem to be associated with postencephalitic Parkinson’s disease, mania, and depression. Viral, neuroanatomic, neurophysiologic, neurochemical, pharmacologic, clinical, and epidemiologic evidence can be found to suggest a connection between the locus ceruleus, the influenza virus, and the induction of a manic psychosis.

[PubMed – indexed for MEDLINE]

A Case of Influenza-Associated Encephalopathy with Psychosis.

A Case of Influenza-Associated Encephalopathy with Psychosis.


Accession number;02A0878590

Title;A Case of Influenza-Associated Encephalopathy with Psychosis.
Author; OSHIRO SATOSHI (Univ. Ryukyus, Fac. Med., JPN) SHIROMA NAOHIDE (Univ. Ryukyus, Fac. Med., JPN) OTA TAKAO (Univ. Ryukyus, Fac. Med., JPN)
Journal Title;Journal of the Japan Pediatric Society
Journal Code:F0896A
Figure&Table&Reference;FIG.2, TBL.1, REF.7
Pub. Country;Japan
Abstract;We reported a 13-years-old boy with psychosis following influenza-like symptoms. He was admitted to our hospital complaining of anxiety and irritability. Though he was suspected to have psychosis on admission, he was diagnosed to suffer from psychosis due to organic disorders, from the both findings of moderate slow basic rhythm on EEG and the regional decreased blood flows in 99mTc-ECD SPECT. His delirium was considered to be caused by influenza-associated encephalopathy on the basis of the elevated influenza-virus A anti-body titer. The children with psychosis following influenza-like symptoms should be carefully examined by the both EEG and SPECT. (author abst.)

Persistent mania and psychosis in a case of novel influenza a (H1N1) virus encephalitis

P01-403 – Persistent mania and psychosis in a case of novel influenza a (H1N1) virus encephalitis

  • Department of Psychiatry, Singapore General Hospital, Singapore, Singapore

Neurologic complications associated with novel influenza A (H1N1) virus infection include seizures, encephalitis, encephalopathy and Reye syndrome. Mania and psychotic episodes are less commonly described, and there have been limited studies on the long-term neuropsychiatric sequelae of H1N1 infection.

Here, we report a case of H1N1 infection with concurrent onset of acute manic and psychotic symptoms. Despite completing a full course of the antiviral medication oseltamivir, the patient’s behaviour worsened over the next four weeks and he required readmission for psychiatric treatment. Based on the temporal sequence of events, we considered the possibility that these symptoms were sequelae of Novel influenza A (H1N1) infection. Moreover, the manic symptoms persisted weeks after the acute infection had abated, which gives rise to the consideration of long-lasting direct or indirect neuronal insult by the influenza virus. However, it is also possible that his symptoms may have represented a primary psychiatric disorder precipitated by or coincident with the viral infection.

After treatment with antipsychotic medication and a mood stabiliser, his manic and psychotic symptoms became significantly attenuated. His behaviour improved considerably such that he was able to return to school. Medications were stopped after one month of outpatient follow-up at his behest. Four months after discharge, he was completely free of symptoms and was performing well in school.

Treatment of influenza with antiviral medications has been shown to reduce the rate of complications. However, the effectiveness of antiviral treatment to prevent influenza-associated neuropsychiatric sequelae is unknown.

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