Assuntos
Transtorno Depressivo Maior/psicologia , Miastenia Gravis/psicologia , Adulto , Comorbidade , Transtorno Depressivo Maior/diagnóstico , Humanos , Masculino , Miastenia Gravis/diagnóstico , Exame Neurológico , Equipe de Assistência ao Paciente , Inventário de Personalidade , Timoma/diagnóstico , Timoma/psicologia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/psicologiaRESUMO
Psychiatric studies were made on 26 inoperable patients with lung cancer or thymic cancer to exam the possible correlation of chemotherapy and chemotherapy-induced nausea and vomiting. All patients were informed of their disease and how to undergo the therapy. Psychiatric tests of CMI (Cornell Medical, Index), MAS (Manifest Anxiety Scale), SDS (Self-Rating Depression Scale) and QOL questionnaire were performed just before the chemotherapy. SDS and QOL questionnaire were also done after chemotherapy. The patients were given chemotherapy including CDDP (80 mg/m2) and anti-emetic agents of 30 mg of azasetron, 750 mg of methylprednisolone and 1,800 mg of domperidone. The patients showing neurosis, anxiety or depression had significantly high nausea scores, so we concluded that psychiatric support was needed to improve these patients' QOL in chemotherapy.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/psicologia , Náusea/induzido quimicamente , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/psicologia , Vômito/induzido quimicamente , Idoso , Depressão , Feminino , Humanos , Masculino , Escala de Ansiedade Manifesta , Pessoa de Meia-Idade , Inventário de Personalidade , Testes Psicológicos , Qualidade de VidaRESUMO
Three patients with neuropsychiatric symptoms (NPSs) associated with thymoma, high serum titers of antiacetylcholine receptor (AchR) antibody and generalized myasthenia gravis (MG) are reported. The NPSs were homogeneous; (1) Altered consciousness as manifested by dreamy state with paramnesia, (2) psychosensory symptoms (the sudden change of senses of smell and taste with behavior abnormalities, auditory and visual hallucinations, déjà experiences, microteleopsia and derealization), (3) cognitive disturbances (recent memory loss with compulsive behaviors), (4) emotional disturbances (agitation, fear and anger), and (5) psychotic symptoms (secondary delusions and hallucinations) were characteristic. The NPSs preceded by several months to years the onset of MG, and thereafter they were closely related to worsening and relapse of MG. A typical patient showed repeatedly abnormal electroencephalograms (EEG) indicative of cerebral dysfunction. Another showed improvement of the NPSs after thymectomy and immunosuppressive therapy. The organicity of the phenomenology of psychoses with the same NPSs was suggested and it appears to comprise a unique paraneoplastic syndrome by central autoimmune mechanism. We proposed an autoimmune psychiatric syndrome and the genesis of psychosis due to the central cholinergic dysfunction in MG.