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Kaur B, Khanna D. A Narrative Review of the Many Psychiatric Manifestations of Neurosyphilis: The Great Imitator. Cureus 2023; 15:e44866. [PMID: 37814742 PMCID: PMC10560128 DOI: 10.7759/cureus.44866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Neurosyphilis is an infection of the central nervous system caused by the spirochete, Treponema pallidum. New syphilis infections have been increasing around the world each year. This disease was much of a concern in the pre-penicillin era, where when left untreated many cases progressed to tertiary syphilis which can commonly manifest as neurosyphilis. Of particular interest, neurosyphilis has been linked to masquerading itself as various psychiatric conditions. This narrative review focuses on exploring psychiatric manifestations of neurosyphilis as well as the importance of screening in psychiatric settings and clinicians maintaining high clinical suspicion of the disease. A systematic search was conducted for published articles from 2003 to 2023 using PubMed, EMBASE, and Google Scholar. A total of 66 articles met the criteria and were used for detailed analysis, where psychiatric manifestations and clinical progression of patients were discussed in detail. Psychiatric manifestations that were explored include dementia, delirium, depression, mania, personality changes, and psychosis. One of the most common manifestations of neurosyphilis appears to be severe neurocognitive impairment. There are also rare psychiatric conditions neurosyphilis mimics that have been described in literature such as Capgras syndrome and Geschwind syndrome. A narrative review of the literature revealed a low level of clinical awareness of neurosyphilis as a possible etiology of various psychiatric disorders. This resulted in delayed or inaccurate diagnosis and consequently delayed initiation of adequate treatment. Considering that many psychiatric manifestations of neurosyphilis are reversible with proper treatment, it is imperative to implement routine screening for syphilis among psychiatric patients.
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Affiliation(s)
- Baneet Kaur
- Department of Medicine, Nova Southeastern University Dr. Kiran C. Patel College Of Osteopathic Medicine, Clearwater, USA
| | - Deepesh Khanna
- Department of Foundational Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
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Olatunde H, Anombem OM, Mantha A, Oladunjoye AO, Hudish T. Manic Episodes in a Patient With Neurosyphilis Following Brief Discontinuation of Bipolar Medication. Cureus 2023; 15:e43604. [PMID: 37719591 PMCID: PMC10504430 DOI: 10.7759/cureus.43604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Bipolar disorder is a mood disorder resulting in episodes of either mania or hypomania. The episodes can manifest themselves as a period of abnormally and persistently elevated mood, abnormally and persistently increased activity or energy, distractibility, insomnia, grandiosity, flight of ideas, increased activity, pressured speech, and racing thoughts. Neurosyphilis is a progression of syphilis infection involving the brain, meninges, or spinal cord. The interaction between bipolar disorder and neurosyphilis has not been extensively studied, but it has been theorized that neurosyphilis can exacerbate mood disorders. This case study details a patient with concurrent late-onset bipolar disorder and neurosyphilis and how the discontinuation of bipolar medication resulted in an acute manic episode. In addition, this case underscores the importance of differentiating the presenting symptoms between bipolar disorder and neurosyphilis.
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Affiliation(s)
- Hafiz Olatunde
- Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, USA
| | | | - Aditya Mantha
- Psychiatry and Behavioral Sciences, The University of Colorado School of Medicine, Aurora, USA
| | - Adeolu O Oladunjoye
- Psychiatry, Baylor College of Medicine, Houston, USA
- Medical Critical Care, Boston Children's Hospital, Boston, USA
| | - Tyler Hudish
- Psychiatry, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, USA
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Vangala S, Beebani G, Thiem R, Dereczyk A. Mania Associated With Supratherapeutic Tacrolimus Levels in a Patient With No Psychiatric History. PSYCHOSOMATICS 2020; 61:769-773. [PMID: 32660875 DOI: 10.1016/j.psym.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sindhura Vangala
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI.
| | - Ganj Beebani
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI
| | - Rachel Thiem
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI
| | - Aimee Dereczyk
- Department of Behavioral Health, Henry Ford Health System, Detroit, MI
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Lee SH, Yang H, Kang NR, Park JH. Re-emerging Neurosyphilis in Korea as a Possible Etiology of Psychotic Disorders with Pleomorphic Symptoms and Cognitive Dysfunction: a Case Report and Literature Review. J Korean Med Sci 2020; 35:e271. [PMID: 32830465 PMCID: PMC7445311 DOI: 10.3346/jkms.2020.35.e271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/18/2020] [Indexed: 01/09/2023] Open
Abstract
Infectious diseases of immigrant populations have recently become important issues for the health of both Korean nationals and foreigners living in Korea. This case report of general paresis is intended to raise awareness about re-emerging neurosyphilis in Korea as a possible etiology of psychotic disorders. A 68-year-old male Chinese resident came to Korea in 2019 with disorientation, auditory hallucination, persecutory delusion, and aggressive behavior, and was admitted to a psychiatric ward for further evaluation and treatment via the emergency department. He was confirmed to have neurosyphilis by serum test, analysis of cerebrospinal fluid, and brain magnetic resonance imaging. After treatment with antibiotics, including intravenous penicillin, in combination with atypical antipsychotics for 6 weeks, his disorientation, auditory hallucination, delusion, and aggressive behavior had attenuated. Neurosyphilis should still be included as a possible etiology of psychotic disorders in Korea. At the initial evaluation, syphilis screening serum tests are recommended for psychotic patients, especially those with pleomorphic symptoms and cognitive dysfunction.
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Affiliation(s)
- Sang Hun Lee
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Hyunju Yang
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
| | - Na Ri Kang
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Neuropsychiatry, Jeju National University School of Medicine, Jeju, Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Korea
- Department of Neuropsychiatry, Jeju National University School of Medicine, Jeju, Korea.
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Ferreri F, Bourla A, Capron J, Quillerou B, Rossignol J, Borden A, Guechot J, Lamaziere A, Nuss P, Mekinian A, Mouchabac S. [Organic and psychiatric intricacy: The complex psychiatric disorder concept, paraclinical investigations]. Presse Med 2019; 48:609-624. [PMID: 31151849 DOI: 10.1016/j.lpm.2019.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
The purpose of this article is to describe complex psychiatric disorders, to recall "minimal classical" explorations in psychiatry, to describe the concept of "complex psychiatric disorders" and to propose a systematized method of exploration. Some organic diseases are well known for their links with psychiatric disorders (manic syndrome and hyperthyroidism, depressive syndrome and corticotropic insufficiency, anxiety disorder and heart disease, etc.). Many other neurological, autoimmune, metabolic, paraneoplastic or endocrine pathologies can have essentially psycho-behavioral manifestations before being neurological or systemic. A large number of factors (nutritional, toxic, immunological, etc.), often ignored, influence the links between organicity and psychiatric pathologies. It is necessary to optimize the medical management of these patients in whom the psychiatric diagnosis masks a curable organo-psychiatric cause.
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Affiliation(s)
- Florian Ferreri
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France
| | - Alexis Bourla
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France.
| | - Jean Capron
- Sorbonne université, Paris Univ-06, Paris, hôpital Saint-Antoine, service de neurologie, 75012, Paris, France
| | - Bluenn Quillerou
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France
| | - Julien Rossignol
- Université Paris 5, hôpital Necker Enfant Malades, service hématologie, 75015 Paris, France
| | - Alaina Borden
- Sorbonne université, Paris Univ-06, Paris, hôpital Saint-Antoine, service de neurologie, 75012, Paris, France
| | - Jérome Guechot
- Sorbonne université, Paris Univ-06, Paris, laboratoire d'hormonologie et immunoanalyse, HUEP, site Saint-Antoine, 75012, Paris, France
| | - Antonin Lamaziere
- Sorbonne université, Paris Univ-06, Paris, laboratoire d'hormonologie et immunoanalyse, HUEP, site Saint-Antoine, 75012, Paris, France; CHU Saint-Antoine, Inserm ERL 1157, 75012 Paris, France; Sorbonne universités-UPMC université Paris 06, UMR 7203, laboratoire des biomolécules, 75005 Paris, France
| | - Philippe Nuss
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France; CHU Saint-Antoine, Inserm ERL 1157, 75012 Paris, France; Sorbonne universités-UPMC université Paris 06, UMR 7203, laboratoire des biomolécules, 75005 Paris, France
| | - Arsène Mekinian
- Sorbonne université, Paris Univ-06, Paris, hôpital Saint-Antoine, service de médecine interne, 75012, Paris, France
| | - Stéphane Mouchabac
- Sorbonne université, Paris Univ-06, Paris, service de psychiatrie et de psychologie médicale, hôpital Saint-Antoine, 75012, Paris, France
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