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Background: Neurosyphilis, also known as "general paresis of the insane," at one time accounted for a large portion of admissions to state psychiatric facilities. With the introduction of antibiotics, neurosyphilis is now considered very rare., Method: Chart review was performed on patients diagnosed with neurosyphilis who were admitted to a state psychiatric hospital in Raleigh, N.C., during 2002., Results: We identified 3 cases of confirmed neurosyphilis, representing 0.1% of adult admissions, diagnosed in newly admitted psychiatric patients. None of the patients were immunocompromised. Response to antibiotic treatment was poor., Conclusions: Given the increase in primary and secondary syphilis reported in the 1980s and early 1990s, routine screening of psychiatric patients for the presence of syphilis should be considered.

In 3 patients, two men aged 34 and 46 years and a woman aged 24 years, who appeared to have psychiatric disorders, neurosyphilis was diagnosed on the basis of screened blood tests. Treatment with intravenous benzylpenicillin alleviated the symptoms. In recent years the incidence of primary syphilis in the Netherlands has risen. There is a wide range of symptoms and the interpretation of serologic results is difficult, especially if there is co-infection with HIV; this disease also increases the chance of progression from primary syphilis to neurosyphilis. Patients admitted to clinical care are usually severely ill and are frequently uncooperative or present unclear histories. Detection at an early stage is vital, as adequate treatment prevents disease progression. This could be achieved by a general screening of clinical psychiatric patients for syphilis in addition to the screening of selected groups.

Data are presented on some of the chief characteristics of a sample of 276 patients (152 women and 124 men) in a long-term state psychiatry facility, who had previously undergone intensive psychiatric treatment. For the women the average age ws 81.6 years, and for the men 75.8 years. The women had slightly more schizophrenia, manic depressive illnesses and cerebrovascular syndromes. The men had distinctly more CNS syphilis and alcoholic dementia. Initially, patients with schizophrenia had been admitted at ages ranging from 15 to 99 years, and those with manic depressive illness at ages ranging from 20 to 70 years. For cerebrovascular syndromes, admissions were concentrated in the age range of 70-90 for women and 65-85 for men. For CNS syphilis, the admissions (for men) were concentrated in the age range of 50-70, and for alcoholic dementia in the age range of 60-80. Length of stay was extremely long for schizophrenic and manic depressive illness and relatively short for cerebrovascular syndromes. However, for the majority of the cerebrovascular patients, the length of stay was at least five years for the men and at least ten years for the women.