Acute psychosis with a mediastinal carcinoma metastasis.
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.
Schönfeldt-Lecuona
Carlos
C
Department of Psychiatry III, University of Ulm, Ulm, Germany.
Freudenmann
Roland W
RW
Tumani
Hayrettin
H
Kassubek
Jan
J
Connemann
Bernhard J
BJ
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
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D014635:Valproic Acid; D010464:Perazine; D000077152:Olanzapine