The successful treatment of disinhibition due to a possible case of non-human immunodeficiency virus neurosyphilis: a proposed pathophysiological explanation of the symptoms and treatment

Gen Hosp Psychiatry. Mar-Apr 2010;32(2):221-4. doi: 10.1016/j.genhosppsych.2009.01.002. Epub 2009 Feb 28.

Abstract

The psychiatric presentation of advanced neurosyphilis is well documented, yet there is no set protocol to treat these occurrences. This report indexes a 61-year-old African-American male with no known psychiatric history but with a pertinent medical history of neurosyphilis (non-human immunodeficiency virus). He developed an acute episode of disinhibition involving violence and poor executive judgment. The authors' propose that this patient's symptoms of disinhibition may have resulted from syphilitic invasion of frontal-subcortical structures, resulting in either top-down or bottom-up dysregulation and deterioration of social behavior. His episode resolved with administration of monotherapy carbamazepine.

Publication types

  • Case Reports

MeSH terms

  • Antipsychotic Agents / therapeutic use*
  • Aripiprazole
  • Carbamazepine / therapeutic use*
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Humans
  • Inhibition, Psychological*
  • Male
  • Middle Aged
  • Neurosyphilis* / cerebrospinal fluid
  • Neurosyphilis* / drug therapy
  • Neurosyphilis* / physiopathology
  • Piperazines / therapeutic use*
  • Quinolones / therapeutic use*

Substances

  • Antipsychotic Agents
  • Piperazines
  • Quinolones
  • Carbamazepine
  • Aripiprazole