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Wilkins CM, Johnson VL, Fargason RE, et al. Psychosis as a sequelae of paraneoplastic syndrome in Small- Cell Lung Carcinoma: A psycho-neuroendocrine interface. Clin Schizophr Relat Psychoses. 2017;doi: 10.3371/CSRP.CWVJ.111717.
Wilkins, C. M., Johnson, V. L., Fargason, R. E., & Birur, B. (2017). Psychosis as a sequelae of paraneoplastic syndrome in Small- Cell Lung Carcinoma: A psycho-neuroendocrine interface. Clinical schizophrenia & related psychoses, . https://doi.org/10.3371/CSRP.CWVJ.111717
Wilkins, Christiana M, et al. "Psychosis as a sequelae of paraneoplastic syndrome in Small- Cell Lung Carcinoma: A psycho-neuroendocrine interface." Clinical schizophrenia & related psychoses vol. (2017). doi: https://doi.org/10.3371/CSRP.CWVJ.111717
Wilkins CM, Johnson VL, Fargason RE, Birur B. Psychosis as a sequelae of paraneoplastic syndrome in Small- Cell Lung Carcinoma: A psycho-neuroendocrine interface. Clin Schizophr Relat Psychoses. 2017 Nov 22; doi: 10.3371/CSRP.CWVJ.111717. Epub 2017 Nov 22. PMID: 29164929.
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Clin Schizophr Relat Psychoses. 2017 Nov 22; doi: 10.3371/CSRP.CWVJ.111717. Epub 2017 Nov 22.

Psychosis as a sequelae of paraneoplastic syndrome in Small- Cell Lung Carcinoma: A psycho-neuroendocrine interface.

Clinical schizophrenia & related psychoses

Christiana M Wilkins, Victoria L Johnson, Rachel E Fargason, Badari Birur

Affiliations

  1. PGY3 Resident, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham.
  2. Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham.
  3. Assistant Professor, Department of Psychiatry and Behavioral Neurobiology, University of Alabama, Birmingham.

PMID: 29164929 DOI: 10.3371/CSRP.CWVJ.111717

Abstract

In 2013 more than 150,000 Americans died from all types of lung cancer. Small cell lung cancer (SCLC) represents about 13% of all lung cancers and is notoriously associated with paraneoplastic syndromes (PNS). Here we present an interesting case of psychosis associated with one such PNS-- ectopic Cushing syndrome of SCLC. A 56 year old African-American male with no prior psychiatric history who was diagnosed with SCLC two months prior, presented to the ER for treatment of a right arm laceration he sustained while fighting off attackers, with high concern these individuals may have been part of hallucinatory experiences and well-systematized persecutory delusions regarding his wife. Physical assessment was notable for Cushingoid symptoms. Initial results of serum ACTH and cortisol were 221pg/ml (10-50pg/ml) and 37.1 mcg/dl (10-20mcg/dl) respectively. For psychosis, patient was started on Olanzapine which was titrated from 5 to final dose of 10mg nightly. Since patient was not a surgical candidate, he was treated with metyrapone 250 mg BID and radiation therapy was continued throughout hospitalization. Serum Cortisol level decreased steadily after initiation of metyrapone and psychotic symptoms dramatically reduced on olanzapine, metyrapone, and radiation therapy with apparently resolved persecutory delusions at discharge. This case broadens the available literature and provides data on successful symptomatic treatment with olanzapine while biological treatments of the underlying condition were beginning to take effect. As SCLC remains an important cause of morbidity and mortality in the US, it is imperative that physicians be aware of paraneoplastic syndromes and their psychiatric sequelae.

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