title: Acute psychosis with a mediastinal carcinoma metastasis.
abstract: BACKGROUND
  Reversible schizophrenia-like syndromes have been reported to occur with small-cell carcinoma of the lung, thymoma, and hematological disorders.
  
  
  METHODS
  A 56-year-old man was admitted due to an acute psychosis characterized by delusions, agitation, and aggressive outbursts. His medical and psychiatric history was unremarkable. On treatment with olanzapine, valproic acid, and perazine there was only moderate improvement. Extensive checkup revealed an isolated mediastinal metastasis of an undifferentiated carcinoma. A primary tumor was not found. After removal of the metastasis, the psychosis remitted rapidly and completely, and the patient remained well on follow-up.
  
  
  CONCLUSIONS
  Paraneoplastic syndromes may clinically present as acute psychoses and, in late-onset schizophreniform disorders with an atypical presentation, performing a tumor search should always be considered.
authors.affiliation: Department of Psychiatry III, University of Ulm, Ulm, Germany.
authors.forename: Carlos
authors.initials: C
authors.lastname: Schönfeldt-Lecuona
authors.forename: Roland W
authors.initials: RW
authors.lastname: Freudenmann
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Tumani
authors.forename: Jan
authors.initials: J
authors.lastname: Kassubek
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Connemann
mesh_terms: D000208:Acute Disease; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D008875:Middle Aged; D000077152:Olanzapine; D020361:Paraneoplastic Syndromes, Nervous System / Q000188:drug therapy / Q000209:etiology*; D010464:Perazine / Q000627:therapeutic use; D011618:Psychotic Disorders / Q000188:drug therapy / Q000209:etiology*; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D014635:Valproic Acid; D010464:Perazine; D000077152:Olanzapine