Hostname: page-component-77c89778f8-m42fx Total loading time: 0 Render date: 2024-07-23T06:53:28.141Z Has data issue: false hasContentIssue false

Brief psychotic disorder mimicking the symptoms of cerebrovascular attack evoked by symptoms that symbolized death in a patient with terminal stage stomach cancer: Case report and review of the literature

Published online by Cambridge University Press:  29 June 2006

HIDEKI ONISHI
Affiliation:
Department of Psychiatry, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
SHIGEKO OKUNO
Affiliation:
Department of Palliative Medicine, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
SUZU YAE
Affiliation:
Department of Palliative Medicine, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
MOTONORI SAIRENJI
Affiliation:
Department of Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
MASANARI ONOSE
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
YASUHIRO MIZUNO
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
CHIAKI KAWANISHI
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan

Abstract

Objective: We report here a terminally ill patient with stomach cancer who developed a brief psychotic disorder mimicking cerebrovascular attack after a short episode of nasal bleeding. Close examination of the patient revealed that nasal bleeding was an event that symbolized deterioration of the general condition leading to death for the patient.

Methods: A 77-year-old male, who was diagnosed as having stomach cancer and was receiving palliative care, presented with tremor and insomnia just after a short episode of nasal bleeding and showed reduced response to stimuli mimicking cerebrovascular attack. Laboratory data were unremarkable. The next day, catatonic behavior developed. He had no history of psychiatric illness or drug or alcohol abuse. After receiving haloperidol, psychiatric symptoms disappeared and he returned to the previous level of functioning within 3 days. The patient explained that he had seen a patient whose general condition deteriorated after nasal bleeding and regarded nasal bleeding as a symptom of deteriorating general condition leading to death and thereafter became afraid of the nasal bleeding.

Results and Significance of results: Although, nasal bleeding is common and usually not severe in medical settings, for the patient, it was an event that symbolized deterioration of the general condition leading to death. Brief psychotic disorder in cancer patients is rare in the literature, although patients receiving terminal care share various kinds of psychological burden. Medical staff in the palliative care unit should be aware of the psychological distress experienced by each patient and consider brief psychotic disorder as part of the differential diagnosis when patients show unexplained neurological-like and/or psychiatric symptoms.

Type
CASE REPORT
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Akechi, T., Okuyama, T., Sugawara, Y., et al. (2004). Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: Associated and predictive factors. Journal of Clinical Oncology, 22, 19571965.Google Scholar
Amberas, A. (1979). Psychologically stressful events in the precipitation of manic episode. British Journal of Psychiatry, 135, 1521.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press.
Beighley, P.S., Brown, G.R., & Thompson, J.W., Jr. (1992). DSM-III-R brief reactive psychosis among Air Force recruits. Journal of Clinical Psychiatry, 53, 283288.Google Scholar
Hughes, J. (1986). Denial in cancer patients. In Coping with Cancer Stress, Stoll, B.A. (ed.), pp. 6369. Dordrecht: Martinus Nijhoff Publishers.
Jorgensen, P. (1985). Long-term course of acute reactive paranoid psychosis. Acta Psychiatrica Scandinavica, 71, 3037.Google Scholar
Kaplan, H.I. & Sadock, B.J. (1995). Textbook of Psychiatry, 6th edition. Baltimore: Williams & Wilkins.
Minagawa, H., Uchitomi, Y., Yamawaki, S., et al. (1996). Psychiatric morbidity in terminally ill cancer patients. Cancer, 76, 11311137.Google Scholar
Onishi, H., Onose, M., Yamada, T., et al. (2003). Brief psychotic disorder associated with bereavement in a patient with terminal stage uterine cervical cancer: A case report and review of the literature. Supportive Care in Cancer, 11, 491493.Google Scholar
Stiefel, F. & Razavi, D. (1994). Common psychiatric disorders in cancer patients. II. Anxiety and acute confusional state. Supportive Care in Cancer, 4, 233237.Google Scholar
Thomas, S.F. & Marks, D.F. (1995). The measurement of coping in breast cancer patients. Psycho-Oncology, 4, 231237.Google Scholar
Tjemsland, L., Soreide, J.A., & Malt, U.F. (1998). Posttraumatic distress symptoms in operable breast cancer III: Status one year after surgery. Breast Cancer Research and Treatment, 47, 141151.Google Scholar