A case of acute psychosis treated with penicillin: An insight into importance of history taking in modern day practice in India

Conference Proceeding

Arunava Datta


Syphilis is caused by the spirochaete Treponema pallidum and is responsible for a variety of symptoms which is responsible for it to be called “the great imitator”. Any syphilitic infection of the central nervous system is called neurosyphilis and it is known to happen in any stage of the treponemal infection. We present a rare case of behavioral abnormalities which was initially not showing sufficient response to conventional psychotropic treatment. Report: A 56 year old male was admitted with complaints of irrelevant talking, profound sleep disturbances, physical and verbal aggressive behavior, fearfulness and suspiciousness which was present for a period of 5 months prior to admission. Detailed history showed that he had multiple sexual partners prior to marriage and no history of any substance use was present. He did not show any response ot conventional psychotropic medications. CSF VDRL was reactive. He was subsequently started on procaine penicillin injections (2.4 million units) intramuscularly for 21 days. He started improving symptomatically from the 10th day of treatment and was symptom free by the end of penicillin therapy. Discussion: Neurosyphilis can present with a plethora of psychiatric manifestations which can either be early/late onset or sudden or insidious onset. Personality changes, forgetfulness, irritability, sleep alterations/disturbances are seen early in the course of the illness. Later emotional lability, confusion, impaired judgment and abstract ability is sometimes seen. Additionally depression, mania and psychosis are also commonly seen in neurosyphilis. Given the low incidence of neurosyphilis nowadays, a high index of suspicion is needed to diagnose such patients adequately. Even today, a thorough and detailed history in all aspects along with a detailed mental status examination is the most important tool for a psychiatrist to come to a diagnosis

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