Syphilis is one of the most common forms of sexually transmitted diseases found abroad and in Russia. This is a chronically ongoing contagious disease that affects all organs and systems of the human body. The appearance of this disease in Europe was associated with the return of the expedition of Christopher Columbus to the shores of America, since the disease spread quickly in the port countries of the Mediterranean Sea, where the sailors returned. Other scientists believed that this disease was known in Europe long before the discovery of America by Columbus and was described in the writings of ancient doctors.

This disease did not yet have a name, but it was told about its manifestations (damage to the mucous membrane, skin, bones) and ways of spread (sexually and domestically). The word "syphilis" began to be used after the appearance in 1530 of the poem "Syphilis, or the French disease" by the Italian physician and philosopher Girolamo Fracastoro, in which it was said that the shepherd Siphilus was punished by the goddess Venus with this disease for insulting the gods. From the name of the shepherd came the name of this disease.

Currently, it is known that the causative agent of the disease is pale treponema (spirochete), which under the microscope is a thin spiral. It is called “pale” because it is poorly stained with special paints. Treponema has the ability to move quickly in a humid environment (in saliva, seminal fluid, breast milk, etc.), in warmth and darkness, so it easily penetrates into various human tissues and organs. On an open surface and in the light, treponema quickly dies. Treponema enters the human body through damaged skin or mucous membranes.

The source of infection is a sick person. Infection occurs through direct close contact with the patient. Ways of infection: sexual and household, but medical workers can become infected from a sick woman or a nurse from someone else's sick child. Very often, infection occurs with alcohol intoxication. Alcohol weakens a person's will, increases sexual desire, but most importantly, people no longer rationally evaluate their actions, and this often contributes to extramarital sex, which can lead to infection with syphilis.

General course of syphilis

In its course, syphilis is divided into a latent (incubation) period and three clinical periods.

Latent, incubation period– from the moment of infection to the manifestation of the first signs of the disease. At this time, the patient may have neurotic reactions in the form of obsessive thoughts about the possibility of infection. Some people do not think about what happened, as the infection often occurs while intoxicated.

the initial period of the disease. At the site of violation of the integrity of the skin or mucous membrane (wound or abrasion), through which the pale spirochete has penetrated (on the genitals, in the oral cavity, on the lips, in the chin area, on the fingers), the first signs of the disease appear in the form of an ulcer with hard edges and bottom. This ulcer is called "hard chancre". The sore is small, painless, covered with a white coating - these are breeding spirochetes. After 7-10 days, the patient notices an increase in regional lymph glands. Unlike men, women often do not show the primary signs of syphilis and are the source of infection. The sore heals quickly, leaving a small mark behind.

Mental disorders that develop in the early periods of syphilis are characterized by the phenomena of asthenia, or neurasthenia, in the formation of which not only the infectious onset of the disease plays a role, but also the psychogenic factor (reaction to infection). Syphilitic asthenia is expressed in sleep disturbance, irritability, fatigue, memory loss, headaches, low mood.

Secondary period of illness occurs 2–3 months after infection and is characterized by high fever, a rash on the skin of the trunk, limbs, on the mucous membranes of the oral cavity, and on the genitals. These lesions are pale pink patches (roseola), flat, copper-colored nodules (papules), or pustules (pustules). Nodules and papules contain live treponemas.

The secondary period, in which there is a high temperature and a rash, is called "typhoid", that is, similar to typhus. In the same period, neurological and mental disorders are observed in patients.

Of the neurological disorders, meningeal symptoms, headaches due to increased intracranial pressure, the disappearance of the pupillary reaction and some tendon reflexes are noted.

From mental disorders, delusions and hallucinations are observed. Taking into account the painful phenomena from the internal organs and joints (the introduction of treponemas and the occurrence of foci of inflammation), patients say in delirium that “they were twisted with iron rods” or “run over by a car”, etc.

If the patient during this period seeks medical help, then he is examined clinically and with the help of the Wasserman serological reaction, specific for syphilis, a diagnosis is made. After the treatment, the patient is under the supervision of a doctor for a long time, receiving several courses of treatment. When there were no antibiotics, treatment was carried out by general therapeutic methods that did not cure the patient, and the disease acquired a protracted chronic character. During this period, gummas formed in various organs and tissues of the body. gummas- this is an accumulation of living spirochetes in various parts of organs and tissues, around which a connective tissue membrane is formed, into which calcium salts settle, compacting it, forming calcifications.

In untreated cases, after 2-3 years, the third stage of the disease develops, called neurosyphilis, i.e. damage to the brain and spinal cord. Gummas are formed in the brain and meninges.

Neurosyphilis can manifest itself in different forms: syphilis of the brain, dorsal tabes and progressive paralysis.

Late tertiary period syphilis, an organic brain lesion occurs: a specific inflammatory process in the membranes of the predominantly base of the brain, sometimes accompanied by the formation of gummous foci - specific leptomeningitis; diffuse damage to small and medium vessels of the brain.

Syphilitic disorders are manifested in the form of a weakening of the psyche (organic asthenia), headaches, memory loss, a decrease in volitional and intellectual activity, increased fatigue and affective lability, sometimes with symptoms of dementia (dementia).

Specific damage to small and medium-sized vessels of the brain leads to the slow development of organic dementia. Patients do not remember or remember with difficulty the dates and names, as well as the events of the previous day. The critical attitude of patients to these defects persists for a long time.

Sometimes the initial symptoms of the disease are persistent headaches, accompanied by a decline in activity, mood disorders and memory loss. As the state deepens, other memory impairments also occur, in particular confabulations and pseudo-reminiscences.

Syphilitic hallucinosis and paranoid are characterized by the appearance of delusions and hallucinations. The sick hear voices scolding them; it seems to them that neighbors or relatives conspire against them. Delusional ideas of relationship and persecution arise. In more severe cases, epileptic seizures may occur.

progressive paralysis- a chronic mental disorder associated with gross disturbances in the substance of the brain can occur 15–25 years after infection with syphilis. The disease was first described by Dr. Bayle in 1822, who gave a clinical description of the disease without knowing the cause. The disease was described as a mental disorder of "unclear etiology". Currently, the disease is detected at earlier stages and is not brought to the stage of progressive paralysis.

The disease begins with neurasthenic symptoms, manifested by headaches, increased irritability, fatigue. With an increase in symptoms, patients lose the ability to notice and evaluate the mistakes they have made. They lose their sense of shyness, neglect the ethical standards of behavior, become rude, cynical, cheeky.

At the stage of development of symptoms in patients, a sign of a progressive weakening of mental activity becomes especially noticeable, the ability to critically comprehend behavior is lost: they spend a large amount of money on things or products that are unnecessary in the house. The feeling of shyness disappears: patients walk casually dressed, they are distinguished by cynical behavior. During this period, delusional statements appear: delusions of enrichment and delusions of grandeur. Patients wear appropriate clothing, uniforms and insignia. Calling themselves the names of great commanders or historical heroes, they wore clothes, epaulettes, orders, and take appropriate poses, according to their ideas. Talking about their riches, they named countless numbers and places of storage (on other planets, in the center of the earth, etc.). At the same time, patients collected food waste and fed on it. All this emphasized the uncriticality of delusional statements and behavioral disorder.

According to their characteristics, these delusional statements are very close to the statements of patients with schizophrenia and for a long time were defined as psychoses (mental disorders) without differentiation by etiological factor. It became possible to carry out differential diagnosis only in 1900, when the Wasserman reaction, specific for syphilis, was created. With progressive paralysis, the Wasserman reaction is sharply positive in the blood and in the cerebrospinal fluid.

In untreated cases, the terminal stage begins early, in which the phenomena of mental and physical disintegration of the personality increase. Patients lose the ability to serve themselves, contact with others, differentiate between edible and inedible, become lethargic, apathetic, lying aimlessly in bed. They have bedsores and insanity early.

Manifestation of syphilis in childhood. From a sick mother, spirochete enters the child during fetal development. The closer the moment of infection of the mother to the period of pregnancy, the less viable the child.

Manifestations of syphilis in a newborn. The child is born with low weight, the skin is pale gray, the subcutaneous fat is poorly expressed. The voice of the newborn is weak. The child takes the breast badly, groans all the time. Already in the first days, small bubbles filled with a cloudy liquid appear on the skin of the whole body, this is the so-called pemphigus. In the amniotic fluid and in the vesicles are living spirochetes. Bubbles merge with each other, especially on the heels, the skin over them stretches, shines ("varnished heels"). In the corners of the lips, wounds form in place of the bubbles. Already in the first days of a child's life, increased sizes of the circumference of the skull, a saddle-shaped nose are observed.

Subsequently, there is a delay in psychomotor and speech development. The child does not react enough to the environment, does not sufficiently differentiate relatives, does not play with toys. Dr. Gutchinson described the specific symptoms of congenital syphilis: keratitis(violation of the iris), which causes a decrease in vision; otitis(chronic inflammation in the middle ear); appearing late teeth with a semilunar notch on the upper incisors. These three symptoms - creatitis, otitis media and specific teeth - are called the "Hutchinson triad". However, a number of characteristic symptoms are described: saber-shaped shins (a bone growth on the tibia), a hydrocephalic skull, bone changes in the skeleton, various malformations of internal organs, and a significant decrease in intelligence. Given the degree of mental retardation, the place and methods of teaching are decided by the medical-psychological-pedagogical commission.

In cases of late intrauterine infection with syphilis, the primary manifestations of the disease are mild. Adolescents may show juvenile progressive paralysis(ages 12–15). The clinical picture in these cases is characterized by an increase in intellectual insufficiency, a loss of the ability to acquire knowledge, improve experience, acquired skills disappear, the ability to critically assess the situation disappears, carelessness and complacency develop. In some cases, juvenile progressive paralysis reveals itself when examining adolescents with mental retardation. Somatic signs of juvenile progressive paralysis are much richer than in adults. In addition to the phenomena of congenital syphilis in the form of various skeletal defects, the Gutchinson triad and other symptoms, there are sometimes sharply reduced nutrition, hypogenitalism, a difference in various hyperkinesias, and coordination of movements. In the study of cerebrospinal fluid, a positive Wasserman reaction is observed. The identified disease is subject to therapeutic effects in a specialized institution.

Prevention of infection with syphilis is propaganda about limiting the free connections of unfamiliar partners, the use of common dishes and linen. Often, syphilis infection occurs during intoxication. If primary signs of the disease are found, then it is necessary to contact a specialized institution. When interviewing a sick person, all possible contacts of the further spread of the disease are identified.

Questions for independent work:

1. What is the difference between somatic and infectious diseases?

2. What causes mental disorders against the background of somatic diseases?

3. What is a neuroinfection? What forms of neuroinfections do you know?

4. Tell us about the differences in mental disorders in meningitis and encephalitis.

5. Tell us about the prevention of infectious diseases in childhood.

6. What kind of help can an educator and teacher provide to children who have had meningitis and encephalitis?

7. What clinical manifestations of syphilis in adults do you know?

8. What methods of diagnosing syphilis are used in medicine?

9. What are the ways to prevent syphilis?

10. In what cases does juvenile progressive paralysis manifest itself?

11. How does syphilis manifest itself in childhood?

12. What is the Gutchinson triad?

13. What prevention methods can a teacher use in conversations with teenagers?

The term syphilitic psychosis is used to generalize all types of mental disorders caused by cerebral syphilis. Such lesions develop as a result of the impact of the disease on the brain and are divided into two large groups: progressive paralysis and cerebral syphilis itself.

Damage to the brain, first of all, provokes such a mental disorder as neurasthenia. The patient becomes lethargic, irritable, constantly complains of headaches and increased fatigue, his performance decreases. When trying to investigate various types of human mental activity, experts note that they have not changed much or are gradually decreasing. A neurological examination shows signs of stigmatization: the pupils react sluggishly to light, tendon reflexes are upset (more often they are elevated). These symptoms are similar to atherosclerosis, but syphilitic lesions begin at an earlier age, which allows for differentiation.

Another form of mental disorder in brain syphilis is plaut hallucinosis. Its manifestations are very similar to schizophrenia, but delusional disorders predominate. This form of mental disorder is characterized by deception of the senses, the occurrence of delusional ideas and hallucinations. There is a delusion of persecution or self-accusation of non-existent misconduct. The delusions themselves are simple and relate either to the environment of the patient, or to life situations that have happened to him.

Progressive paralysis was once described as an independent disorder of the human nervous system, however, at the end of the 19th century, Wasserman discovered spirochetes in the blood, and a couple of decades later, another scientist, H. Noguchi, identified it in the brain. So it became clear that this disease often causes psychosis.

As a rule, more than 10 years pass from the moment of infection to the first manifestations of mental disorders in syphilis. All this time, the symptoms are growing, coming to light gradually. Disorders begin with the fact that a person becomes less efficient, his memory begins to fail him in elementary matters, some processes are more difficult than usual. The mood also changes. At first, the patient becomes irritable. He is pissed off by moments that he had never paid attention to before, and he reacts to everything extremely inadequately. Sleep disorders begin.

Further mental manifestations of syphilis of the brain are even more serious: a personality disorder begins. The patient becomes indifferent to what he used to be interested in, even members of his own family do not care about him. He may lose his modesty, become sloppy, wasteful, and even begin to use foul language, even if he has never done so before. The next stage is dementia, expressed by serious memory disorders.

Treatment of such forms of syphilis implies the usual antibiotic therapy for such diagnoses. The most important thing is not to belittle the significance of symptoms unusual for a person - for example, signs of syphilitic psychosis are often attributed to fatigue, lack of proper rest, and stress. Many even try to cope with the problem by contacting a psychoanalyst, not suspecting what kind of illness is developing inside them. Unfortunately, the prognosis for this disease can be completely different: it all depends on the timeliness of detection and the correctness of the prescribed treatment, of course, only under strict medical supervision.

Mental disorders as a result of syphilitic damage to the brain manifest themselves in various stages of the disease and tend to progress.
In case of syphilitic damage to the brain, individual independent clinical forms of syphilis of the brain (with primary damage to the meninges and vessels of the brain) and progressive paralysis (with primary damage to the substance of the brain - its parenchyma) are isolated, based on the localization and the period that has elapsed since the onset of the disease with syphilis. Both syphilis of the brain and progressive paralysis result from infection with a pale spirochete, but they differ sharply in the time of onset of the disease, in the nature and localization of the pathological process, and also in the clinical picture.
Progressive paralysis has recently been extremely rare, although in line with the increase in the incidence of syphilis at the present time, one can assume an increase in the number of patients with progressive paralysis in a few years.

267 Chapter 21

Mental disorders in syphilis of the brain

Psychopathological manifestations of brain syphilis are very diverse and are mainly due to the stage of the disease, localization and prevalence of the pathological process.
Mental disorders in brain syphilis are similar to psychopathological symptoms in other organic diseases of the brain: encephalitis, meningitis, tumors, vascular diseases. With this in mind, in their diagnosis and differentiation from other diseases, characteristic neurological symptoms, as well as the results of laboratory tests, are of great importance.
The most common psychopathological syndrome of stage I-II of brain syphilis is neurosis-like (syphilitic neurasthenia), in which neurotic, hypochondriacal and depressive disorders are observed. Symptoms such as severe irritability, emotional lability, complaints of headaches, memory impairment, and a drop in working capacity predominate. Gradually formed lacunar (partial) dementia.
There are characteristic pupillary disorders (lethargy of the pupils' reaction to light), pathology of the cranial nerves, meningeal symptoms, epileptiform seizures. A positive Wasserman reaction in the blood and unstable are detected. - in the cerebrospinal fluid, moderate pleocytosis (cell shift), positive globulin reactions, pathological curves in the Lange reaction (liquid color change in the first 3-5 tubes - "syphilitic tooth" 11232111000, in 5-7 tubes - "meningitis curve" 003456631100).
Stages II and III of syphilis are characterized by psychoses, which are classified according to the leading syndrome. There are syphilitic psychoses with hallucinatory-delusional, pseudo-paralytic (progressive dementia) syndromes and disorders of consciousness according to delirious and twilight types.
The hallucinatory-delusional syndrome with syphilis of the brain often begins with the appearance of auditory hallucinations: the patient hears insults, abuse addressed to him, often cynical sexual reproaches, soon the patient becomes completely uncritical to these disorders, believes that he is being pursued by murderers, thieves, etc. .

268 Section III. Separate forms of mental illness

Against the background of hallucinatory-delusional disorders, episodes of disturbed consciousness with speech and motor excitation can be observed.
Hallucinatory-delusional syndrome with syphilis of the brain must be differentiated from the corresponding syndromes of schizophrenia and alcoholic psychosis.
With syphilis of the brain, delusions and hallucinations have a mundane content, are associated with an emotional component, develop against the background of an organic change in personality with typical disorders of memory and thinking, while in schizophrenia they are abstract, signs of emotional impoverishment of the personality, impaired thinking are found. In alcoholic psychosis, alcoholic personality changes take place.
With a syphilitic process, there are always characteristic neurological and somatic signs of this disease, as well as relevant laboratory data.
With pseudo-paralytic syndrome against the background of dementia of the organic type (partial, lacunar), which, with development, increasingly acquires a picture of a global one (complete, with a breakdown of all, including criticism, manifestations of the intellect), a benevolent background of mood prevails, patients are euphoric, can express delusional ideas of greatness of fantastic content.
Sometimes there are epileptiform seizures, strokes.
In addition to these important psychotic syndromes, delirious and twilight disorders of consciousness can be observed.
The variety of clinical manifestations, as already mentioned, depends on the characteristics of the pathological process, its localization and prevalence, the duration from the moment of infection, the severity of the syphilitic infection, and the premorbid characteristics of the organism. Pathological (microscopic) examination reveals the predominance of cerebral vascular lesions, mainly of small caliber.
Signs of an inflammatory process are observed in the vessels and membranes of the brain against the background of chronic pathomorphological changes. Patochemical methods reveal disorders of carbohydrate (mucopolysaccharides) metabolism in the brain. Mental disorders are expressed more often in those forms of syphilis of the brain, in which there were no gross focal disorders.
The whole variety of pathomorphological (with microscopic examination) changes in the brain can be reduced to

269 ​​Chapter 21

syphilitic gums, which can be multiple of different sizes, a diffuse inflammatory process - meningitis and vascular lesions with a picture of obliterating endarteritis.
With syphilis of the brain, specific therapy is carried out. All patients who have syphilis of the brain are sent for treatment to a psychiatric hospital.
Treatment. The main and most common treatment for syphilis of the brain is penicillin therapy (at least 12,000,000 units for a course of treatment). Conduct several courses. With repeated courses, it is advisable to prescribe prolonged forms of penicillin - ekmonvocillin 300,000 IU intramuscularly 2 times a day.
Antibiotic treatment is combined with iodine and bismuth preparations. For a course up to 40 g of biyoquinol. These drugs are used in combination with vitamins, especially group B, and general restorative treatment is also carried out.
For the treatment of patients with mental disorders, psychotropic drugs are used, depending on the leading syndrome.
Due to the variety of clinical manifestations, forensic psychiatric examination of brain syphilis should not be determined by only one diagnosis of the disease; in each case, an expert opinion is issued individually, taking into account the specific manifestations of the disease.
In psychotic forms, as well as severe dementia and personality degradation, patients with brain syphilis are insane.
Currently, when conducting a forensic psychiatric examination, patients are most often encountered who, due to long-term and thorough treatment of syphilis, have only minor mental disorders. Such persons are critical of their condition, retain professional knowledge and skills, and therefore, during a forensic psychiatric examination, they are recognized as sane in relation to the acts incriminated to them.

A syphilitic infection can lead to severe brain damage many years after infection. There are early forms of damage - syphilis of the brain and late - progressive paralysis.

progressive paralysis

Manifestations of this disease begin 10-15 years after infection. The clinical picture unfolds in three stages.

first stage progressive paralysis is called pseudoneurasthenic, since the complaints of patients resemble neurotic symptoms. Patients report persistent and frequent headaches, memory loss, decreased performance, irritability. They sometimes commit unethical acts that are contrary to their upbringing. The first neurological symptoms appear, dysarthria occurs. Serological and immunological reactions are positive. The first stage of progressive paralysis lasts about a year.

Second stage progressive paralysis (the stage of developed signs of the disease) is determined by the leading psychopathological syndrome. Most common expansive(manic) form. There are delusions of grandeur, absurd in content, disinhibition of drives, cynicism.

depressive the form of progressive paralysis is characterized by a sharp decrease in mood, ideas of self-blame, fear of impending death, an abundance of hypochondriacal complaints, reaching on a large scale to Kotard's nihilistic delirium (statement that the whole organism has rotted).

Agitated - the form of the disease is manifested by a sharp psychomotor agitation. Patients sing, shout, dance, suddenly aggressively attack others, tear their clothes; then they scatter food around, cynically swear.

At dementia form, along with the weakening of the intellectual abilities of patients, ridiculous and cynical forms of behavior are noted, the feeling of distance disappears when communicating with others; they are intrusive in requests, unceremonious with people of any age and social status.

Usually the pathological process is localized in the frontal lobes of the brain. If other areas are also affected, additional symptoms may occur.: aphasia, agnosia, apraxia, incoordination.

Progressive paralysis can begin (when infected by a household route) at 12-15 years of age. This form of the disease is called youthful; it proceeds according to the type of dementia, but it is characterized by a malignant course, leading to deep dementia within one year.

Third stage various forms of progressive paralysis manifest themselves in the same way and are called the stage of physical and mental insanity. Dystrophy progresses rapidly, non-healing trophic ulcers are formed. Mental regulation of behavior becomes impossible.

Syphilis of the brain

It develops 5-10 years after infection. It affects the vessels of the brain, accompanied by repeated hemorrhages in the brain with an increase in dementia, or proceeds with the formation of syphilitic gums in the brain. Patients have frequent headaches, disorders of consciousness such as deafness or twilight states, psychosensory disorders, delusions and hallucinations; paralysis, paresis, speech, hearing, vision disorders are possible, epileptiform seizures occur.

Depending on the prevailing symptoms, the following forms of brain syphilis are distinguished: neurasthenic, apoplectiform, epileptiform, syphilitic hallucinosis and hallucinatory-paranoid.

Treatment mental disorders in syphilis, it is necessary to begin with the appointment of antisyphilitic drugs - biyoquinol, novarsenol, miarsenol, sodium iodide; antibiotics - penicillin, rifampicin.

See mental disorders in infectious and somatic diseases

Saenko I. A.

Sources:

1. Bortnikova S. M., Zubakhina T. V. Nervous and mental diseases. Series "Medicine for you". Rostov n/a: Phoenix, 2000.
2. Nursing guide / N. I. Belova, B. A. Berenbein, D. A. Velikoretsky and others; Ed. N. R. Paleeva.- M.: Medicine, 1989.
3. Kirpichenko A. A. Psychiatry: Proc. for honey. in-comrade. - 2nd ed., revised. and additional - Mn.: Vysh. school, 1989.