Turan Senol, Emul Murat, Duran Alaattin, Mert Ali, Ugur Mufit
Department of Psychiatry, Medical Faculty of Istanbul University, Turkey.
J Psychopharmacol. 2007 Jul;21(5):556-8. doi: 10.1177/0269881106071033. Epub 2006 Nov 8.
The clinicians usually do not consider syphilis in the differential diagnosis for patients with acute and chronic psychiatric symptoms. To familiarize clinicians particularly with neurosyphilis (NS) and to discuss the atypical antipsychotic alternatives, we wish to present a case with agitated, resistant psychotic symptoms related to neurosyphilis. The case was a 55-year-old male who has had anxiety, irritability, auditory hallucinations, ataxia, dysarthric speech, paranoid and persecutory delusions and agitated behaviour. Parenteral ziprasidone 20 mg/bid was initialized at the first day of admission to reduce agitation. Then it was switched to olanzapine velotab 10 mg/bid because of inefficacy. Parenteral cephtriaxon 1 g/daily was administered because of seropositive VDRl and TPHA and positive cerebrospinal fluid VDRl. Olanzapine velotab may be a good alternative antipsychotic and should be considered in reducing agitation and psychotic symptoms in NS.
临床医生在对患有急慢性精神症状的患者进行鉴别诊断时，通常不会考虑梅毒。为了让临床医生尤其熟悉神经梅毒（NS）并讨论非典型抗精神病药物的替代方案，我们希望呈现一例与神经梅毒相关的伴有激越、难治性精神病症状的病例。该病例为一名55岁男性，有焦虑、易怒、幻听、共济失调、构音障碍、偏执和被害妄想以及激越行为。入院第一天开始静脉注射齐拉西酮20mg/每日两次以减轻激越。因无效，随后换用奥氮平速释片10mg/每日两次。因梅毒血清学反应素试验（VDRl）和梅毒螺旋体血凝试验（TPHA）呈血清阳性且脑脊液VDRl呈阳性，给予静脉注射头孢曲松1g/每日。奥氮平速释片可能是一种很好的抗精神病替代药物，在减轻神经梅毒患者的激越和精神病症状时应予以考虑。
