[Personality and behavioural disturbances, with delusional-hallucinatory and delirium episodes in the course of hyponatremia due to paraneoplastic inappropriate vasopressin secretion (SIADH)].
OBJECTIVE
To broaden the knowledge about somatic mechanisms of psychic disturbances.


METHODS
Presentation of a 54 year old male with psychic disturbances and hyponatremia.


RESULTS
After six months with head ache, nausea, exhaustion, irritability, lacking drive, and appetite--acute psychic disturbances abruptly arose. These recurrent episodes with agitation, aggression, delusions, hallucinations, sometimes--disorientation and memory loss; appearing simultaneously with hyponatremia (Na in blood 104-118 mEq/L); were classified as organic delusional disturbances, and (in case of disorientation and memory loss) as delirium (F06.2, F05 - in ICD-10). The symptoms were manifested for 6 months and were classified as personality disturbances due to brain dysfunction (F07.8 in ICD 10). The acute psychic disturbances interrupted the hospitalization in the medical ward, twice and caused three psychiatric hospitalizations; until the diagnosis of hyponatremia in the course of inappropriate vasopressin secretion (SIADH), due to small cell carcinoma of the left lung was established.


CONCLUSIONS
The SIADH syndrome with hyponatremia, and polymorphic psychic disturbances had preceded the clinical and radiological manifestations of the hidden development of left lung small cell carcinoma for a long time. The legitimated involuntary admission to a psychotic ward in a general hospital with easy access to specialized laboratory tests and consultations facilitated establishing the diagnosis. The restriction of water administration with oral salt supplementation stabilized the psychic state and enabled treatment in the Institute of Oncology. The case illustrates the complicated somatic mechanisms of psychic disturbances and the necessity of multi-specialist cooperation in the border area between psychiatry and other medical disciplines.
Załuska
Maria
M
IV Klinika Psychiatrii IPiN w Warszawie, Cegłowska.
Janota
Bertrand
B
Papierska
Lucyna
L
D018288:Carcinoma, Small Cell / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy; D003693:Delirium; D003702:Delusions; D006801:Humans; D007010:Hyponatremia; D007177:Inappropriate ADH Syndrome / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009384:Paraneoplastic Endocrine Syndromes / Q000209:etiology*