General paralysis of the insane

General paresis
Classification and external resources
Specialty	infectious disease
ICD-10	A52.1
ICD-9-CM	090.40 094.1
MedlinePlus	000748
MeSH	D009494
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General paresis, also known as general paralysis of the insane or paralytic dementia, is a severe neuropsychiatric disorder, classified as an organic mental disorder and caused by the chronic meningoencephalitis that leads to cerebral atrophy in late-stage syphilis. Degenerative changes are associated primarily with the frontal and temporal lobar cortex. The disease affects approximately 7% of infected individuals. It prevails among men.

GPI was originally considered to be a type of madness due to a dissolute character, when first identified in the 18th Century. Then the cause-effect connection with syphilis was discovered in the late 1880s. Subsequently, the discovery of penicillin and its use in the treatment of syphilis rendered paresis curable and avoidable. Prior to that, paresis was inevitably fatal unless another terminating illness intervened, and accounted for as much as 25% of the primary diagnosis for residents in public psychiatric hospitals.

Symptoms of the disease first appear from 10 to 30 years after infection. Incipient GPI is usually manifested by neurasthenic difficulties, such as fatigue, headaches, insomnia, dizziness, etc. As the disease progresses, mental deterioration and personality changes occur. Typical symptoms include loss of social inhibitions, asocial behavior, gradual impairment of judgment, concentration and short-term memory, euphoria, mania, depression, or apathy. Subtle shivering, minor defects in speech and Argyll Robertson pupil may become noticeable.

Delusions, common as the illness progresses, tend to be poorly systematized and absurd. They can be grandiose, melancholic, or paranoid. These delusions include ideas of great wealth, immortality, thousands of lovers, unfathomable power, apocalypsis, nihilism, self-blame, or bizarre hypochondriacal complaints. Later, the patient suffers from dysarthria, intention tremors, hyperreflexia, myoclonic jerks, confusion, seizures and severe muscular deterioration. Eventually, the paretic dies bedridden, cachectic and completely disoriented, frequently in a state of status epilepticus.

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