Journal of Mental Science (1931) 77: 86-118. doi: 10.1192/bjp.77.316.86
© 1931 The Royal College of Psychiatrists
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Investigations into the Prolonged Treatment of General Paralysis with Tryparsamide*

Thomas Tennent, M.D., D.P.H., D.P.M., Senior Assistant Medical Officer

Maudsley Hospital

* An abstract of a thesis accepted by the University of Glasgow for the degree of M.D.

ABSTRACT

Summary and Conclusions:

  1. Fifty cases of general paralysis were submitted to treatment by tryparsamide. Seventeen were treated by this drug alone, and in 33 others the drug was combined with fever therapy.
  2. Of these, 36% have had a good remission; 32% have had a partial remission, 14% are unimproved and 18% are dead.
  3. The effect of treatment is influenced by the duration of the mental symptoms prior to treatment, by the age of the patient and by the clinical type of the illness.
  4. The chances of a successful outcome after treatment diminish in direct ratio to the duration of the mental symptoms prior to treatment.
  5. The chances of remission are diminished with the increase of years over 40 years of age.
  6. The most favourable types in order of degree of improvement are the manic type, the euphoric type, the simple type and the tabo-paretic type.
  7. The outlook is much better in the simple "apathetic" type than in the simple "fatuous" type.
  8. The speech defect and the tremors have been the neurological signs which showed the most improvement as the result of treatment. The changes in the reflexes were slight and inconstant The changes in the pupillary reactions were likewise variable. No pupil which was inactive prior to treatment showed a response after treatment.
  9. In the early stages the clinical and serological changes do not run parallel. A partial parallelism exists in the later period, as all cases then showing clinical improvement show a concomitant serological improvement.
  10. Complications resulting from treatment by tryparsamide in this series have been very few. Visual disturbances occur in a small percentage of cases, and are sufficiently important to demand a careful ophthalmoscopic examination of all patients prior to treatment. The best method of administration of the drug is the intravenous one. It should not be administered subcutaneously, nor intramuscularly. No bad results have followed its extravasation in small amounts into the tissues around the veins. The drug is not cumulative, and has been administered regularly at weekly intervals over a period of many months without any detrimental effects.
  11. Tryparsamide is a most valuable drug in the treatment of general paralysis of the insane and the results obtained in this series are encouraging. It forms a valuable substitute for fever therapy where the latter is contra-indicated, but the most effective method of treatment consists in a combination of tryparsamide with fever.