The Emergence of a Psychotic Disorder With a Diagnosis of Breast Cancer Metastasized to the Brain: A Case Report

It is known that psychotic patients have a reduced ability to evaluate reality and self-care. However, no case has been reported in which a breast lump was misdiagnosed as an insect bite and neglected, and a diagnosis of psychotic disorder led to metastatic breast cancer. A 44-year-old woman diagnosed with invasive breast cancer with brain metastasis became unresponsive with little reaction to verbal communication as a result of successive life-threatening events. After her presentation to the emergency department, she was diagnosed with metastatic breast cancer as a result of detailed examinations. The patient, who did not have any psychiatric illness or alcohol or drug addiction in her medical history, was so insensitive to herself and her environment that she could not notice the large mass in her breast and the bad odors coming from her. According to these findings, the patient was suspected to have a psychotic disorder accompanied by substupor, and olanzapine 2.5 mg/day was administered. If the diagnosis of psychotic disorder is not recognized and treated, the highly visible breast lump may be misperceived and cancer treatment may be delayed, thus the cancer may progress. Early recognition and treatment of mental disorders affect the mortality and morbidity of patients.

Psychological symptoms of illness and emotional distress in advanced cancer cachexia

PURPOSE OF REVIEW

Cachexia induces both physical and psychological symptoms of illness in patients with advanced cancer and may generate emotional distress in patients and families. However, physical symptoms of cachexia received the most emphasis. The aims of this review are to elucidate a link between systemic inflammation underlying cachexia and psychological symptoms and emotional distress, and to advance care strategy for management of psychological symptoms and emotional distress in patients and families.

RECENT FINDINGS

The main themes in the literature covered by this review are psychological symptoms in patients and emotional distress in patients and families. Studies of the underlying biology of cachexia identify the role of the central nervous system to amplify tumor-induced systemic inflammation. The brain mediates a cluster of symptoms, such as sleep disruption, anxiety, cognitive impairment, and reduction in motivated behavior (notably anorexia). These are distressing to patients as well as to families.

SUMMARY

There is growing recognition that holistic multimodal interventions are needed to alleviate psychological symptoms and emotional distress and to improve quality of life in patients with cancer cachexia and families. This is an approach that addresses not only physical health but also psychological, emotional, and social well being issues.