General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail.

1.
Hahn RC, Webster B, Weickhardt G, Thomas E, Timberlake W, Solomon H, Stokes JH, Heyman A, Gammon G, Gleeson GA, Curtis AC, Cutler JC: The results of treatment in 1,086 general paralytics the majority of whom were followed for more than five years. J Chronic Dis 1958;7:209-227.
2.
Hare EH: The origin and spread of dementia paralytica. J Ment Sci 1959;105:594-626.
3.
Daey Ouwens IM, Koedijk FD, Fiolet AT, van Veen MG, van den Wijngaard KC, Verhoeven WM, Egger JI, van der Sande MA: Neurosyphilis in the mixed urban-rural community of the Netherlands. Acta Neuropsychiatr 2014;26:186-192.
4.
Bogousslavsky J, Moulin T: Birth of modern psychiatry and the death of alienism: the legacy of Jean-Martin Charcot; in Bogousslavsky J (ed): Following Charcot: A Forgotten History of Neurology and Psychiatry. Front Neurol Neurosci. Basel, Karger, 2011, vol 29, pp 1-8.
5.
Thompson M: The wages of sin: the problem of alcoholism and general paralysis in nineteenth-century Edinburgh; in Bynum W, Porter R, Shepherd M (eds): The Anatomy of Madness: The Asylum and Psychiatry. London, Routledge, 1988, vol 3, pp 316-337.
6.
Davis G: The most deadly disease of asylumdom: general paralysis of the insane and Scottish psychiatry, c.1840-1940. J R Coll Physicians Edinb 2012;42:266-273.
7.
Merritt HH, Adams RD, Solomon HC: Neurosyphilis. New York, Oxford University Press, 1946, pp 175-219.
8.
Davis G: ‘The Cruel Madness of Love': Sex, Syphilis and Psychiatry in Scotland, 1880-1930. Amsterdam, Editions Rodopi B.V., 2008, pp 176-189.
9.
Pearce JM: Brain disease leading to mental illness: a concept initiated by the discovery of general paralysis of the insane. Eur Neurol 2012;67:272-278.
10.
von Krafft-Ebing R: Aetiologie der Progressive Paralyse. Comptes-Rendus du XII Congrès International de Médecine, Moscou, 7 (19)-14 (26) août 1897. Moscow, Roth, 1900, vol 1, pp 871-872.
11.
Hauser RI: Sexuality, Neurasthenia and the Law: Richard von Krafft-Ebing (1840-1902). Doctoral Thesis, University of London, 1992.
12.
Hurn JD: The History of General Paralysis of the Insane in Britain, 1830-1950. University of London, 1998.
13.
Braslow JT: The influence of a biological therapy on physicians' narratives and interrogations: the case of general paralysis of the insane and malaria fever therapy, 1910-1950. Bull Hist Med 1996;70:577-608.
14.
Slijkhuis J, Oosterhuis H: Cadaver brains and excesses in Baccho and Venere: dementia paralytica in Dutch psychiatry (1870-1920). J Hist Med Allied Sci 2014;69:426-460.
15.
Kraepelin E: General Paresis. New York, Nervous and Mental Disease Publishing Company, 1913, p 72.
16.
Wing JK, Cooper JE, Sartorius N: Measurement and Classification of Psychiatric Symptoms: An Introduction Manual for the PSE and Catego Program. Cambridge, Cambridge University Press, 1980.
17.
Vijselaar J: Het Gesticht: Enkele Reis of Retour [The Asylum: One Way or Round Trip]. Amsterdam, Boom, 2011, pp 83-122.
18.
Artvinli F: More than a disease: the history of general paralysis of the insane in Turkey. J Hist Neurosci 2014;23:127-139.
19.
Vijselaar J: Het Gesticht: Enkele Reis of Retour [The Asylum: One Way or Round Trip]. Amsterdam, Boom, 2011, pp 16-19.
20.
Berrios GE: ‘Depressive pseudodementia' or ‘melancholic dementia': a 19th century view. J Neurol Neurosurg Psychiatry 1985;48:393-400.
21.
Kraepelin E: General Paresis. New York, Nervous and Mental Disease Publishing Company, 1913, pp 59-66.
22.
Berrios GE: Dementia: historical overview; in Burns A, Levy R (eds): Dementia. London, Chapman & Hall, 1994, p 5.
23.
Kraepelin E: General Paresis. New York, Nervous and Mental Disease Publishing Company, 1913, pp 16-43.
24.
Pearce JM: The Argyll Robertson pupil. J Neurol Neurosurg Psychiatry 2004;75:1345.
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