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Seritan AL. Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review. J Geriatr Psychiatry Neurol 2023; 36:435-460. [PMID: 36941085 PMCID: PMC10578041 DOI: 10.1177/08919887231164357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background: Approximately 15% of older adults may experience psychotic phenomena. Primary psychiatric disorders that manifest with psychosis (delusions, hallucinations, and disorganized thought or behavior) account for less than half. Up to 60% of late-life psychotic symptoms are due to systemic medical or neurological conditions, particularly neurodegenerative diseases. A thorough medical workup including laboratory tests, additional procedures if indicated, and neuroimaging studies is recommended. This narrative review summarizes current evidence regarding the epidemiology and phenomenology of psychotic symptoms encountered as part of the neurodegenerative disease continuum (including prodromal and manifest stages). Results: Prodromes are constellations of symptoms that precede the onset of overt neurodegenerative syndromes. Prodromal psychotic features, particularly delusions, have been associated with an increased likelihood of receiving a neurodegenerative disease diagnosis within several years. Prompt prodrome recognition is crucial for early intervention. The management of psychosis associated with neurodegenerative diseases includes behavioral and somatic strategies, although evidence is scarce and mostly limited to case reports, case series, or expert consensus guidelines, with few randomized controlled trials. Conclusion: The complexity of psychotic manifestations warrants management by interprofessional teams that provide coordinated, integrated care.
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Affiliation(s)
- Andreea L. Seritan
- University of California, San Francisco Department of Psychiatry and UCSF Weill Institute for Neurosciences, CA, USA
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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: 0] [Impact Index Per Article: 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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Doufik J, Zemmama H, Bouri S, Rabhi S, Boujraf S, Aalouane R, Rammouz I. Prevalence of sexually transmitted infections in patients with schizophrenia in Morocco. Infect Dis Now 2022; 52:304-305. [PMID: 35248765 DOI: 10.1016/j.idnow.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/31/2021] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES People with schizophrenia are likely to be overrepresented in high-risk categories for sexually transmitted infections (STIs). We aimed to determine the seroprevalence of HIV, HBV, HBC, and syphilis in these patients. PATIENTS AND METHODS Sociodemographic and clinical characteristics of 444 patients were collected, as well as risk factors for STIs. Serological tests were performed. RESULTS Lifetime seroprevalence rates were 0.0% for HIV, 1.6% for HBV, 0.9% for HBC, and 3.6% for syphilis. These figures are lower than those reported in the general population except for syphilis. Only 0.45% of patients were seropositive for both HBV and syphilis. CONCLUSION No higher rates of HBV, HBC, and HIV seroprevalence were observed compared with the general population, except for syphilis.
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Affiliation(s)
- J Doufik
- Health sciences research Laboratory. Faculty of medicine, Ibn Zohr University, 80000, Agadir, Morocco.
| | - H Zemmama
- Laboratory of clinical neurosciences, Faculty of Medicine Fez, Sidi Mohamed Ben Abdellah University, 30000, Fez, Morocco
| | - S Bouri
- Laboratory of clinical neurosciences, Faculty of Medicine Fez, Sidi Mohamed Ben Abdellah University, 30000, Fez, Morocco
| | - S Rabhi
- Department of Internal Medicine, Faculty of Medicine Fez, Sidi Mohamed Ben Abdellah University, 30000, Fez, Morocco
| | - S Boujraf
- Laboratory of clinical neurosciences, Faculty of Medicine Fez, Sidi Mohamed Ben Abdellah University, 30000, Fez, Morocco
| | - R Aalouane
- Laboratory of clinical neurosciences, Faculty of Medicine Fez, Sidi Mohamed Ben Abdellah University, 30000, Fez, Morocco
| | - I Rammouz
- Health sciences research Laboratory. Faculty of medicine, Ibn Zohr University, 80000, Agadir, Morocco
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Gao JH, Li WR, Xu DM, Zheng BW, Huang YM, Wu WQ, Zhang W. Clinical Manifestations, Fluid Changes and Neuroimaging Alterations in Patients with General Paresis of the Insane. Neuropsychiatr Dis Treat 2021; 17:69-78. [PMID: 33469294 PMCID: PMC7812051 DOI: 10.2147/ndt.s279265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE We aim to study the clinical manifestations, fluid changes and neuroimaging alterations in patients with general paresis of the insane (GPI). METHODS A total of 119 patients suffering from GPI recruited in Beijing Ditan Hospital, Capital Medical University from 2010 to 2020 were retrospectively analyzed. RESULTS In 119 GPI patients, 103 cases (86.6%) were male. Misdiagnosed rate was up to 83.2%, schizophrenia and mood disorders were the most common misdiagnosed diseases. Duration from symptom onset to the final confirmed diagnosis was 10.4±12.9 months. The main clinical manifestations included cognitive impairment (114 cases, 95.8%) and neuropsychiatric symptoms (107 cases, 90.0%). The cognitive domains including the delayed recall, visuospatial/executive function and language ability indicated by MoCA score were damaged severely. Rapid plasma regain (RPR) of all GPI patients was 100% positive in serum and 89.9% positive in cerebral spinal fluid (CSF). The white blood cell (WBC) number in CSF was between 6 and 50/μL in 73 GPI patients (61.3%). The protein level was between 45.1 and 70mg/dL in 47 cases (39.5%). In the 110 cases, 96 cases (87.3%) were abnormal indicated by cerebral atrophy mostly located in the anterior brain and abnormal signals distributed in various regions of the brain mostly in the frontal lobe and temporal lobe. CONCLUSION The symptoms of GPI were complex and easy to misdiagnose. The clinicians were still short of vigilance for neurosyphilis. We should expand serologic testing for syphilis especially in patients with cognitive impairment and neuropsychiatric symptoms. We suggest syphilis curricula in the training program of the clinicians especially for neurologist and psychiatrist.
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Affiliation(s)
- Jun-Hua Gao
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wu-Rong Li
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dong-Mei Xu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Bo-Wen Zheng
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yu-Ming Huang
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wen-Qing Wu
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Zhang
- Center for Cognitive Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Cassiani-Miranda CA, Chen X. Neurocognitive disorder due to neurosyphilis: a case report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 49:202-207. [PMID: 32888665 DOI: 10.1016/j.rcp.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/17/2018] [Accepted: 10/16/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Neurosyphilis is a chronic infectious disease caused by Treponema pallidum that can cause a great variety of neuropsychiatric signs and symptoms, which complicates its diagnosis. CASE DESCRIPTION This case occurred in a 40-year-old man who consulted the Emergency Department because of a convulsion (de novo) which was related to a chronic condition of cognitive impairment and psychosis. The appropriate studies were performed for the diagnosis of neurosyphilis and the recommended treatment was initiated. The patient presented clinical improvement and was discharged. DISCUSSION Positive VDRL serology results and imaging findings of marked cortical atrophy conducted to consider a late-stage parenchymatous neurosyphilis with serious cognitive impairment and associated psychosis. Treatment with crystalline penicillin was formulated, which reduced the intensity of the patient's symptoms; however, the patient's lack of interest to attend the check-ups significantly reduces his chances of an adequate recovery. CONCLUSIONS Neurosyphilis must be suspected in patients with clinically evident neurological or psychiatric symptoms. Analysis of VDRL serology and neuroimaging studies are important as an initial evaluation of the patient and must be complemented with cognitive tests or mental examination to determine the state of cognitive impairment.
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Affiliation(s)
| | - Xueyi Chen
- Semillero de Investigación en Psiquiatría de Enlace-Grupo de Investigación en Neuropsiquiatría, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
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Neurosyphilis Presenting as Mania and Psychosis After Incidental Treatment With Cephalexin: A Case Report and Literature Review of Jarisch-Herxheimer Reactions. PSYCHOSOMATICS 2020; 61:177-180. [DOI: 10.1016/j.psym.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
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7
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Goutte J, Killian M, Antoine JC, Massoubre C, Fakra E, Cathébras P. [First-episode psychosis as primary manifestation of medical disease: An update]. Rev Med Interne 2019; 40:742-749. [PMID: 31421899 DOI: 10.1016/j.revmed.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/09/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022]
Abstract
A huge variety of medical diseases may potentially present with isolated psychotic symptoms, and disease-specific treatment or management is available for a significant part of them. The initial medical work-up of a first-episode psychosis (FEP) is of crucial importance. This literature review aimed to identify medical conditions potentially revealed by FEP, to list the warning signs of secondary psychosis, and to discuss a screening strategy. Underlying organic conditions may be drugs and medications, neurologic diseases, infections, inflammatory and/or autoimmune pathologies, and metabolic disorders whether of hereditary origin. Each patient presenting with a first-episode psychosis should be evaluated with a precise anamnesis, a careful clinical examination, and routine laboratory tests. Brain imaging and tests (depending on the context) should be performed in the presence of atypical clinical features or "red flags", leading to suspect an organic disease.
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Affiliation(s)
- J Goutte
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - M Killian
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - J C Antoine
- Service de neurologie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - C Massoubre
- Service de psychiatrie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - E Fakra
- Service de psychiatrie, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne Cedex 2, France.
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8
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Qi S, Xu Y, Luo R, Li P, Huang Z, Huang S, Nie T, Zhang Q, Li Q. Novel Biochemical Insights in the Cerebrospinal Fluid of Patients with Neurosyphilis Based on a Metabonomics Study. J Mol Neurosci 2019; 69:39-48. [DOI: 10.1007/s12031-019-01320-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/16/2019] [Indexed: 12/12/2022]
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9
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Memantine Rescues Neurosyphilis-Related Schizophrenic-like Features and Cognitive Deficit. Clin Neuropharmacol 2019; 42:133-135. [PMID: 31135390 DOI: 10.1097/wnf.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Neurosyphilis, an infectious neuroinflammatory disorder, could cause diverse neuropsychiatric symptoms mimicking disorders of schizophrenia and dementia; hence, it is known as the "chameleon of psychiatry." Here, we present a subject with neurosyphilis with schizophrenic features and share the treatment outcome. METHODS A 42-year-old single man had schizophrenic-like features and cognitive dysfunction for 1 year. Neurosyphilis was confirmed by a cerebral spinal fluid study. The brain image revealed multiple punctuated white matter gliosis in the bilateral frontal lobes and old lacunar infarctions in the bilateral basal hippocampus. The neuropsychiatric functions were declined until adjunctive memantine therapy. RESULTS With the add-on therapy of memantine 10 mg daily, the psychotic and dementic symptoms markedly improved, and the patient recovered to the premorbid state in the 2-year follow-up course. CONCLUSIONS Memantine has an adjunctive effect on neurosyphilis-related neuropsychiatric disorder via modulation of the glutamatergic neurotransmission and microglia-induced neuroinflammation.
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A Case Report of Neurosyphilis Limbic Encephalitis With Reversible Geschwind Syndrome and Mood Disorder. J Psychiatr Pract 2019; 25:222-226. [PMID: 31083037 DOI: 10.1097/pra.0000000000000390] [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] [Indexed: 12/17/2022]
Abstract
Limbic encephalitis is an inflammatory process of the limbic structures, with polymorphic clinical features, caused by paraneoplastic and nonparaneoplastic conditions and infections. We describe a case of neurosyphilis limbic encephalitis, presenting with reversible Geschwind syndrome (hyperreligiosity and hypergraphia) and mood disorder due to the predominant involvement of left mesial temporal structures in a previously healthy 34-year-old, left-handed woman. Because neurosyphilis can mimic common neuropsychiatric syndromes, it should be included in the differential diagnosis of psychiatric disorders with suspected general medical causes. This case of nondominant limbic encephalopathy caused by syphilis infection highlights the relevance of a careful investigation for secondary psychotic, mood, and personality disorders when assessing new-onset psychiatric illness and the importance of a multidisciplinary approach to provide a better outcome in patients with neurosyphilis.
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11
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Jiang MJ, Zhang HJ, Li WR, Wu WQ, Huang YM, Xu DM, Qi YY, Qin KY, Zhang L, Zhang JL. Analysis of EEG Lemple-Ziv complexity and correlative aspects before and after treatment of anti-syphilis therapy for neurosyphilis. Neurol Res 2019; 41:199-203. [PMID: 30912484 DOI: 10.1080/01616412.2018.1520438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective To investigate the diagnostic value of electroencephalogram (EEG) complexity in patients with neurosyphilis by comparing the changes of electroencephalogram Lempel-Ziv complexity (EEG-LZC) before and after anti-syphilis treatment. Methods The EEG complexity of neurosyphilis patients diagnosed in our hospital from July in 2015 to June in 2017 was analyzed and compared with other diagnostic results such as serology examination and cerebrospinal fluid examination. Results A total of 27 patients were diagnosed, including 19 males and 8 females, of which 6 were mesenchymal(cerebrospinal membrane and meningeal vascular), 16 were parenchymal(paralytic dementia, spinal cord tuberculosis and optic neuropathy), and 5 were asymptomatic. After intensive anti-syphilis therapy, the LZC increased significantly in all patients while the trend and degree of change were consistent with other diagnostic results. Conclusion The LZC can be used as one of the diagnostic indexes meanwhile the trend and degree of its change can be used as the reference index of curative effect to neurosyphilis.
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Affiliation(s)
- M J Jiang
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - H J Zhang
- b Department of Urology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - W R Li
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - W Q Wu
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - Y M Huang
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - D M Xu
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - Y Y Qi
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - K Y Qin
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - L Zhang
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
| | - J L Zhang
- a Department of Neurology , Beijing Ditan Hospital, Capital Medical University , Beijing , China
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Zhang Q, Xie JJ. Association between schizophrenia and syphilis: a retrospective study in Xiamen, China. BMC Psychiatry 2018; 18:273. [PMID: 30176838 PMCID: PMC6122212 DOI: 10.1186/s12888-018-1869-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have shown that patients with mental illnesses such as schizophrenia have a higher risk for syphilis infection. However, the clinical characteristics of psychotic patients who are infected with syphilis remain unknown. The aim of this study was to investigate the prevalence of syphilis in psychotic patients in Xiamen and to compare the social function and serum biochemical markers between schizophrenia patients with and without syphilis. METHODS There were a total of 1586 psychotic patients screened for syphilis from May 2016 to August 2017 in Xiamen Mental Health Center. We retrospectively studied 87 schizophrenia patients in this study. The NOSIE-30 score and serum biochemical markers were analyzed for all schizophrenia patients. RESULTS The seroprevalence of syphilis was 3.3% (52/1586) in our study. Schizophrenia patients infected with syphilis (SCZ-S) showed a higher irritability score compared with patients without syphilis (SCZ-C) (p < 0.05). Similarly, the serum CK, CK-MB, K and Cl values were significantly higher in the SCZ-S group than in the SCZ-C group (P < 0.05). In addition, the CK levels in SCZ-S drug-free patients were significantly higher than in drug-free patients in the SCZ-C group (P < 0.05). CONCLUSION The seroprevalence of syphilis was 3.3% (52/1586) in our study, which revealed that psychotic patients were at high risk of being infected with Treponema pallidum. In addition, schizophrenia patients infected with syphilis can be more irritable and could have disrupted electrolyte and CK and CK-MB levels.
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Affiliation(s)
- Qiao Zhang
- Xiamen Xianyue Hospital, Xiamen Mental Health Center, Xiamen, 361004 Fujian China
| | - Jia-Jiang Xie
- Xiamen Xianyue Hospital, Xiamen Mental Health Center, Xiamen, 361004, Fujian, China.
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Das S, Kalyan A, Garg K, Thirthalli J, Math SB. A case of very early neurosyphilis presented as schizophrenia-like psychosis. Asian J Psychiatr 2018; 31:92-93. [PMID: 29453149 DOI: 10.1016/j.ajp.2018.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 11/25/2022]
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Boller F, Caputi N. Thomas Mann's depiction of neurosyphilis and other diseases. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2018; 27:1-9. [PMID: 28471291 DOI: 10.1080/0964704x.2017.1315288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Thomas Mann (1875-1955), a Nobel Prize recipient rightly considered one of the great novelists of the twentieth century, was one of the most medically perceptive writers of recent times. His novels take place against the background of the different plagues (tuberculosis, cholera) that characterized the eighteenth and nineteenth centuries. One of Mann's later novels, Doctor Faustus, is set against a background of syphilis. In the 500-page book, which is subtitled The Life of the German Composer Adrian Leverkühn as told by a Friend, we see the theologian turned composer make a pact with the devil. He "voluntarily" contracts syphilis and, as a result of the pact and despite (or because of) the disease, Leverkühn starts a brilliant 24-year career, becoming the greatest German composer of his time. While it is widely thought that Arnold Schoenberg (1874-1951) is the model for Leverkühn, we will show that other composers of the time also inspired the fictitious musician's life and works. We will also illustrate the parallel between Leverkühn's disease progression and political events in Germany in the 1930s and 1940s and their similarity with current political events.
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Affiliation(s)
- François Boller
- a Department of Neurology , George Washington University Medical School , Washington , DC , USA
| | - Nicoletta Caputi
- a Department of Neurology , George Washington University Medical School , Washington , DC , USA
- b Department of Life, Health and Environmental Sciences , University of L'Aquila , L'Aquila , Italy
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15
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Liu H, Zhao ZB, You NX. Diversity in clinical manifestations and imaging features of neurosyphilis: obstacles to the diagnosis and treatment (report of three cases). Int J Neurosci 2017; 128:785-790. [PMID: 29199527 DOI: 10.1080/00207454.2017.1412963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Hui Liu
- Department of Neurology and Institute of Neurology, Changshu No.2 Hospital affiliated to Yangzhou University School of Medicine, Suchow, PR China
| | - Zong-Bo Zhao
- Department of Neurology and Institute of Neurology, Changshu No.2 Hospital affiliated to Yangzhou University School of Medicine, Suchow, PR China
| | - Nian-Xing You
- Department of Neurology and Institute of Neurology, Changshu No.2 Hospital affiliated to Yangzhou University School of Medicine, Suchow, PR China
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[Chronic course of neurosyphilis]. DER NERVENARZT 2017; 89:586-588. [PMID: 29188351 DOI: 10.1007/s00115-017-0465-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE After the prevalence of syphilis had reached historic lows, the Center for Disease Control devised a plan to eradicate syphilis in the United States. Since that decree there has been a dramatic rise in new cases. Psychosis is an ominous symptom of neurosyphilis. METHODS We report a case of neurosyphilis that was misdiagnosed and staged incorrectly. RESULTS Failure to diagnose neurosyphilis was associated with prolonged psychosis that has been refractory to antipsychotic treatment. CONCLUSION Psychiatrists should renew their vigilance for neurosyphilis in the setting of a positive screening test and psychosis.
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Wang C, Wu K, Yu Q, Zhang S, Gao Z, Liu Y, Ni L, Cheng Y, Guan Z, Shi M, Lu H, Lou Y, Zhou P. CXCL13, CXCL10 and CXCL8 as Potential Biomarkers for the Diagnosis of Neurosyphilis Patients. Sci Rep 2016; 6:33569. [PMID: 27650493 PMCID: PMC5030708 DOI: 10.1038/srep33569] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 08/23/2016] [Indexed: 01/03/2023] Open
Abstract
At present, diagnosis for neurosyphilis remains a major clinical challenge. Venereal Disease Research Laboratory (VDRL) titer of the cerebrospinal fluid (CSF) is suboptimally sensitive to diagnose neurosyphilis, which can be negative in neurosyphilis patients, especially in asymptomatic neurosyphilis patients. In the search for biomarkers of neurosyphilis, we investigated the chemokine profile in CSF of neurosyphilis patients and found that the concentrations of CXCL13, CXCL10 and CXCL8 were selectively elevated in neurosyphilis patients and correlated with CSF protein concentration and CSF-VDRL titer. After antibiotic treatment, the concentration of these chemokines was dramatically reduced. The area under the ROC curve (AUC) of CSF CXCL13, CXCL8,CXCL10 and the CSF/serum ratio of CXCL13, CXCL8,CXCL10 in the diagnosis of neurosyphilis were 0.940, 0.899, 0.915, 0.963, 0.846 and 0.926, respectively. The corresponding sensitivities/specificities of CSF CXCL13, CXCL8,CXCL10 and the CSF/serum ratio of CXCL13, CXCL8,CXCL10 in diagnosis of neurosyphilis were 85.4%/89.1%, 79%/90.1% and 79.6%/91.1%, 86.6%/99%, 79%/73.3% and 86%/92.1%, respectively. Our results suggest that the elevated concentrations of CXCL13, CXCL8, and CXCL10 or their increasing CSF/serum ratios may be potential biomarkers of neurosyphilis, particularly for asymptomatic neurosyphilis. Reduced concentration of these chemokines may indicate the prognosis of antibiotic therapy.
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Affiliation(s)
- Cuini Wang
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, P. R. China
| | - Kaiqi Wu
- School of Laboratory Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qian Yu
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, P. R. China
| | - Sufang Zhang
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, P. R. China
| | - Zixiao Gao
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, P. R. China
| | - Yudan Liu
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, P. R. China
| | - Liyan Ni
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, P. R. China
| | - Yuanyuan Cheng
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, P. R. China
| | - Zhifang Guan
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, P. R. China
| | - Mei Shi
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, P. R. China
| | - Haikong Lu
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, P. R. China
| | - Yongliang Lou
- School of Laboratory Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Pingyu Zhou
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, P. R. China.,Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, P. R. China
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Yanhua W, Haishan S, Le H, Xiaomei Z, Xinru C, Ling L, Zhangying W, Dong Z, Yuefen Z, Yan T, Xinni L, Sha L, Yuping N. Clinical and neuropsychological characteristics of general paresis misdiagnosed as primary psychiatric disease. BMC Psychiatry 2016; 16:230. [PMID: 27400713 PMCID: PMC4940705 DOI: 10.1186/s12888-016-0925-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/15/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neurosyphilis is caused by the invasion of Treponema pallidum into the central nervous system. General paresis (GP) is a type of neurosyphilis. The main manifestation of general paresis is dementia; however, this is different from the other types of dementia, which can be cured by adequate doses of penicillin in the early stage. Neurosyphilis is the "great imitator" because it can mimic many types of medical disorders. In addition, the manifestations of neurosyphilis are not typical. Psychiatric disorders as a cause of general paresis have become more common due to the use of antibiotics. Patients with a psychiatric manifestation are often misdiagnosed. The purpose of this study was to explore the differences in the clinical and neuropsychological characteristics of general paresis between patients misdiagnosed as having a primary psychiatric disease and patients diagnosed correctly upon seeing a doctor. The results may assist clinicians in the early identification of neurosyphilis with a mental disorder. METHOD The demographic and clinical manifestations, laboratory tests, and neuroimaging and neuropsychological characteristics were analysed in 55 general paresis patients with psychiatric disorders, including 29 patients misdiagnosed as primary psychiatric disease and 26 patients diagnosed as having general paresis after being seen once by a doctor. RESULT All of the patients had positive assay results for cerebral spinal fluid (CSF) Treponema pallidum hemagglutination (TPHA). Only 43.3 % of misdiagnosed patients and 30.8 % of general paresis patients had positive results for the CSF rapid plasma reagin (RPR) test; 96.4 % patients had abnormal neuroimaging. Mood disturbances were the most common psychiatric disorder in the general paresis patients, especially agitation, between the two groups (patients with general paresis who were misdiagnosed as having primary psychiatric disease and patients who had never been misdiagnosed) (p = 0.011). CONCLUSION Our findings reinforce the importance of performing serologic testing for syphilis. This should be a part of the evaluation of patients with psychiatric disorders, especially patients with cognitive impairment. When the syphilis serology is positive, the patient should be examined thoroughly for neurosyphilis by lumbar puncture. Brain imaging could also aid the physician in discriminating these patients from those with a functional mental disorder.
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Affiliation(s)
- Wang Yanhua
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Shi Haishan
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Hou Le
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Zhong Xiaomei
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Chen Xinru
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Li Ling
- Department of Psychiatry, Sun Yat-sen University, Guangzhou Brain Hospital, Guangdong, China
| | - Wu Zhangying
- Department of Psychiatry, Guangzhou Medical University, Guangzhou Brain Hospital, Guangdong, China
| | - Zheng Dong
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Zhang Yuefen
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Tan Yan
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Luo Xinni
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China
| | - Liu Sha
- Department of Radiology, Guangzhou Brain Hospital, Guangdong, China
| | - Ning Yuping
- Department of Neurology, Guangzhou Brain Hospital, Guangdong, China.
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20
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Lawrie SM, O'Donovan MC, Saks E, Burns T, Lieberman JA. Towards diagnostic markers for the psychoses. Lancet Psychiatry 2016; 3:375-85. [PMID: 27063388 DOI: 10.1016/s2215-0366(16)00021-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 12/06/2015] [Accepted: 01/15/2016] [Indexed: 12/15/2022]
Abstract
Psychotic disorders are currently grouped under broad phenomenological diagnostic rubrics. Researchers hope that progress in identifying aetiological mechanisms will ultimately enable more precise division of heterogeneous diagnoses into specific and valid subgroups. This goal has been an aim of psychiatry since the 19th century, when patients with general paresis were thought to have "insanity" similar to dementia praecox and manic depressive illness. Nowadays, the constructs of organic-induced and substance-induced psychotic disorder show that our diagnostic classification system already reflects, in part, aetiological factors. Most recently, gene copy number variation and autoimmunity have been associated with schizophrenia. We suggest how, on the basis of recent scientific advances, we can progress the identification of further putative subgroups and make the most of currently available interventions. Prompt diagnosis and treatment, and a more routine search for causes, could preserve function and improve outcome, and therefore be more acceptable to patients and carers.
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Affiliation(s)
- Stephen M Lawrie
- Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK.
| | - Michael C O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Elyn Saks
- USC Gould School of Law, University of Southern California, Los Angela, CA, USA
| | - Tom Burns
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jeffrey A Lieberman
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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21
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Abstract
A large number of patients with neurosyphilis present dementia with a progressive course and psychiatric symptoms such as depression, mania, and psychosis. Despite prompt and proper antibiotic treatment, the recovery is often incomplete, especially when tissue damage has occurred. We reported a patient with persisted cognitive decline associated with neurosyphilis that improved substantially after donepezil therapy. A 43-year-old man manifested significant psychiatric symptoms such as mania, psychosis, and cognitive impairment due to neurosyphilis. Subsequently, the patient was treated with antipsychotics and donepezil concurrent with an adequate antibiotic treatment for neurosyphilis. During the 1-year follow-up, his rapid plasma reagin titer approached from 1:256 to 1:64. His Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale scores improved from 12 to 25 and 42.3 to 6.3, respectively, after a 6-month donepezil treatment. Donepezil was discontinued. Three months later, worsening of cognitive impairment (MMSE score, 23) was noted. After donepezil was started again for 3 months, his MMSE score improved to 26. Persistent cognitive impairment is commonly associated with neurosyphilis despite adequate penicillin treatment. Treatment of the cognitive impairment is important but difficult. Cholinergic pathways are considered as involving in the cognitive deficit induced by neurosyphilis and donepezil, a cholinesterase inhibitor, which may be useful for the improvement of cognition. In this case report, we described for the first time the successful use of donepezil in treating cognitive impairment associated with neurosyphilis. The role of cholinesterase inhibitors in the treatment of cognitive impairments caused by neurosyphilis needs further studies.
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22
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Enaw JOE, Smith AK. Biomarker Development for Brain-Based Disorders: Recent Progress in Psychiatry. ACTA ACUST UNITED AC 2013; 1:7. [PMID: 25110721 DOI: 10.13188/2332-3469.1000006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Biomarkers are biological measures that are indicative of a specific disorder, its severity or response to treatment. They are widely used in many areas of medicine, but biomarker development for brain-based disorders lags behind. Using examples from the field of psychiatry, this article reviews the concepts of biomarkers, challenges to their development and the recent progress along those lines. In addition to discussing historical biomarker candidates such as cortisol or catecholamine levels, we include progress from recent genetic, epigenetic, proteomic, neuroimaging and EEG studies. Successful identification of biomarkers will advance the field of psychiatry towards the goal of biological tests for diagnosis, symptom management and treatment response.
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Affiliation(s)
- James O Ebot Enaw
- Department of Psychiatry & Behavioral Sciences, Emory University, School of Medicine, Atlanta, GA, USA
| | - Alicia K Smith
- Department of Psychiatry & Behavioral Sciences, Emory University, School of Medicine, Atlanta, GA, USA
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