Letters to the editor
Medwave 2016 Ene-Feb;16(1):e6869 doi: 10.5867/medwave.2017.01.6869

The Zika virus beyond microcephaly: will we face an increase in mental disorders?

Julio Torales, Iván Barrios

Dear editor:

On January 15, 2016, the United States’ Centers for Disease Control and Prevention recommended pregnant women not to travel to areas where the Zika virus (ZIKV) was spreading. Only six months later, the ZIKV outbreak was already affecting more than 60 countries or territories [1],[2].

Serious birth defects, including microcephaly, are confirmed consequences of both symptomatic and asymptomatic ZIKV infection [1]. However, the consequences of ZIKV infection could go way beyond microcephaly [3]

Schizophrenia and other mental disorders have no single cause. The conditions are thought to arise from a combination of factors, including genetic predisposition and traumas later in life, such as sexual or physical abuse, abandonment or heavy drug use. Additionally, evidence has increased for years that mental disorders may be linked to exposure during pregnancy to viruses like rubella, herpes and influenza [4], and to parasites like Toxoplasma gondii. 

ZIKV bear a resemblance to some pathogens that have been linked to the development of schizophrenia, autism and bipolar disorder [3],[4],[5]. At this time, it is uncertain to define the final consequences of ZIKV infection in the central nervous system development and the possible emergence of mental disorders. Some authors have argued that neuronal migration, cellular organization, and myelination could be impaired by central nervous system infection, leading to different conditions, including major and minor brain malformations, and neuropsychiatric syndromes including intellectual impairment and autism [3]

In order to be prepare and address this possible increasing of mental disorders due to ZIKV infection, the thoughtful study of longitudinal cohorts of newborns from epidemic areas, involving methodical assessment of neurodevelopmental milestones [3], should be a priority in the coming years. In the meantime, general clinicians and psychiatrists should be trained on the neural consequences of ZIKV infection, in order to address the challenges ahead. 


From the editor
The authors originally submitted this article in Spanish and English. The Journal has not copyedited this English version. 

Conflicts of interest
Authors declare no conflicts of interest. 

The authors declare not having received any funding for this letter.

  1. Frieden TR, Schuchat A, Petersen LR. Zika Virus 6 Months Later. JAMA. 2016 Oct 11;316(14):1443-1444. | CrossRef | PubMed |
  2. Adams L, Bello-Pagan M, Lozier M, Ryff KR, Espinet C, Torres J, et al. Update: Ongoing Zika Virus Transmission - Puerto Rico, November 1, 2015-July 7, 2016. MMWR Morb Mortal Wkly Rep. 2016 Aug 5;65(30):774-9. | CrossRef | PubMed |
  3. Simões E Silva AC, Moreira JM, Romanelli RM, Teixeira AL. Zika virus challenges for neuropsychiatry. Neuropsychiatr Dis Treat. 2016 Jul 14;12:1747-60. | CrossRef | PubMed |
  4. Boksa P. Maternal infection during pregnancy and schizophrenia. J Psychiatry Neurosci. 2008 May;33(3):183-5. | PubMed |
  5. Torales Benítez J, Rodríguez Marín H, López Olmedo P, Recalde Berni S. Esquizofrenia y otros Trastornos Psicóticos. En: El Libro Azul de la Psiquiatría. Asunción: EFACIM; 2012:107-128.


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