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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 ,
SHIGEKO OKUNO ,
SUZU YAE ,
MOTONORI SAIRENJI ,
MASANARI ONOSE ,
YASUHIRO MIZUNO  and
CHIAKI KAWANISHI
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
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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.

Keywords

Brief psychotic disorderCancerPsychological distressBereavement
Type
CASE REPORT
Information
Palliative & Supportive Care , Volume 4 , Issue 1 , March 2006 , pp. 87 - 89
Copyright
© 2006 Cambridge University Press

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References

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