BACKGROUND: Neurosyphilis, caused by METHODS: A retrospective study used data from the Chinese Case Report System (CCRS) spanning 2014-2018. Four municipal psychiatric hospitals in Guangdong were chosen based on syphilis rates and psychiatric patient volumes. Sociodemographic data, syphilis history, symptoms, diagnostic and treatment details, and laboratory results were reviewed. The Brief Psychiatric Rating Scale (BPRS) assessed psychopathology symptoms. Treatment efficacy was evaluated using BPRS scores before and after standard treatment. Diagnoses followed national guidelines, with statistical analyses performed using logistic regression and RESULTS: Out of 69,436 psychosis patients screened, 1588 were diagnosed with syphilis, with 262 (16.5%) of these cases identified as neurosyphilis. Syphilis prevalence mildly declined from 2.8% (2014) to 2.0% (2016), while neurosyphilis cases increased marginally from 0.34% (2014) to 0.39% (2018). Confirmatory Cerebrospinal Fluid (CSF) tests were conducted in only 30.2% of neurosyphilis cases. Standard therapy was administered to 66.8% of patients, with significantly better outcomes in confirmed cases ( CONCLUSIONS: Diagnosing and treating neurosyphilis in Guangdong's psychiatric hospitals remains challenging. Accurate diagnosis and standardized treatment protocols are essential to effectively manage both syphilis and associated mental health complications caused by neurosyphilis.