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.
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