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The syphilis-madness connection: How did it go from an infectious disease to a fatal neuropsychiatric disease?
Syphilis's place in history is not only as a symbol of infectious disease, but is also closely linked to a neuropsychiatric condition known as "general paresis" or "mad general paresis." The disease is caused by late-stage syphilis, with consequences such as chronic meningoencephalitis and brain atrophy, and can become fatal if not treated promptly. The disease was first identified in the early 19th century and was originally viewed as a degenerate form of madness. In the late 1880s, the relationship between general paralysis and syphilis was first discovered.
General paralysis affects approximately 7% of people infected with syphilis and is particularly common in developing countries where treatment resources are relatively scarce.
Symptoms of general paralysis usually appear 10 to 30 years after infection. Early symptoms include fatigue, insomnia and headaches, while as the disease worsens, patients may experience mental breakdown and personality changes. These classic symptoms include decreased social inhibition and a gradual decline in judgment and short-term memory. They may experience mood swings of euphoria, mania, depression, or apathy, and may experience delusions that are often less systematic and more absurd, and may include a grandiose thought of great wealth or immortality.
One of the hallmarks of the disease is abnormal pupil reflexes (Argyle-Robertson pupil), which can later develop into dysreflexia of the muscles and seizures.
Although there have been records of remissions in the prognosis of the disease, even so, almost all patients will relapse within a few months or years. The mortality rate from general paralysis was once very high, accounting for about 25% of patients admitted to psychiatric hospitals at the time. With the discovery of organoarsenic compounds such as svaricella and cysteine and the widespread use of penicillin, the treatability of the disease has improved, making general paralysis less common.
Over the next few decades, this syphilitic psychosis gradually became a thing of the past.
Many famous people throughout history have fallen victim to generalized paralysis. For example, American officer Randall MacKenzie, Theo van Gogh, brother of famous painter Vincent van Gogh, and even the notorious gangster Al Capone. Their stories not only reveal the link between infectious diseases and mental illness, but also reflect the ignorance of syphilis and its consequences.
Today, with the advancement of medical technology and the improvement of society's awareness of sexually transmitted diseases, syphilis and the general paralysis caused by it have become relatively rare. Even in some developing countries, the epidemiology of this disease is under effective control. While we have access to modern medical care, we still need to reflect on our understanding of early symptoms and our awareness of these potentially fatal diseases.
Are the lessons behind syphilis and general paralysis reminding us to treat these seemingly distant diseases and symptoms more seriously?
