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REGULAR ARTICLES   |    
Psychiatric Manifestations as Primary Symptom of Neurosyphilis Among HIV-Negative Patients
Li-Rong Lin, M.Med.; Hui-Lin Zhang, M.Med.; Song-Jie Huang, M.Med.; Yan-Li Zeng, M.Med.; Ya Xi, M.Med.; Xiao-Jing Guo, M.Med.; Gui-Li Liu, M.Med.; Man-Li Tong, M.Med.; Wei-Hong Zheng, M.Med.; Li-Li Liu, M.Med.; Tian-Ci Yang, Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:233-240. doi:10.1176/appi.neuropsych.13030064
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The authors report no financial relationships with commercial interests.

Li-Rong Lin, Hui-Lin Zhang, and Song-Jie Huang contributed equally to this article.

From the Center of Clinical Laboratory, Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China (LRL, HLZ, SJH, YLZ, YX, XJG, GLL, MLT, LLL, TCY); Xiamen Zhongshan Hospital, Fujian University of Traditional Chinese Medicine, Xiamen, China (LRL, LLL, TCY); Department of Neurology, Zhongshan Hospital, Medical College of Xiamen University, Xiamen, China (WHZ); and ShenZhen Research Institute of Xiamen University, ShenZhen, China (TCY)

Send correspondence to Dr. Yang or Dr. Liu; e-mail: yantianci@xmu.edu.cn; liulili@xmu.edu.cn

Copyright © 2014 by the American Psychiatric Association

Received March 19, 2013; Revised April 24, 2013; Accepted April 26, 2013.

Abstract

This study characterizes psychiatric manifestations as a primary symptom of neurosyphilis (NS). Fifty-two of the 169 NS patients presented with psychiatric manifestations, many patients had characteristics of more than one syndrome, including cognitive impairment, personality disorders, delirium, hostility, dysarthria, confusion, disruption of their sleep-wake cycle, fecal and urinary incontinence, dysphoria, paranoia, hallucinations, expansive mood, and mania. Fifty-two patients had positive sera RPR and T. pallidum particle agglutination (TPPA), 75% had positive CSF RPR, 96.2% had positive CSF TPPA, 44.2% had CSF pleocytosis and elevated CSF proteins, and 70.0% had nonspecific, abnormal brain MRIs. These results indicate that NS mimics almost all psychiatric disorders.

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FIGURE 1. RPR Reactivity Among 52 NS Patients with Psychiatric Manifestations

FIGURE 2. T. Pallidum particle agglutination (TPPA) Reactivity Among 52 NS Patients with Psychiatric Manifestations
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TABLE 1.Original Diagnoses of 41 NS Patients with Psychiatric Manifestations as the Primary Symptom
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TABLE 2.Neurologic and Psychiatric Symptoms from 52 NS Patients with Psychiatric Manifestations
Table Footer Note

a Indicates neurological symptoms.

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TABLE 3.Clinical Signs From 52 NS Patients with Psychiatric Manifestations
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