Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-23T04:28:44.408Z Has data issue: false hasContentIssue false
  • English
  • Français

Conversion disorder with convulsion and motor deficit mimicking the adverse effects of high-dose Ara-C treatment in a posttransplant acute myeloid leukemia patient: A case report and review of the literature

Published online by Cambridge University Press:  01 March 2004

HIDEKI ONISHI ,
AKI KAMIJO ,
MASANARI ONOSE ,
TOMOKI YAMADA ,
YASUHIRO MIZUNO ,
MIZUHO ITO ,
HIDEYUKI SAITO  and
ICHIRO MARUTA
HIDEKI ONISHI
Affiliation:
Department of Psychiatry, Kanagawa Prefecture Cancer Center, Yokohama, Japan
AKI KAMIJO
Affiliation:
Department of Hematology, Kanagawa Prefecture Cancer Center, Yokohama, Japan
MASANARI ONOSE
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
TOMOKI YAMADA
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
YASUHIRO MIZUNO
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
MIZUHO ITO
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
HIDEYUKI SAITO
Affiliation:
Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
ICHIRO MARUTA
Affiliation:
Department of Hematology, Kanagawa Prefecture Cancer Center, Yokohama, Japan
Get access Rights & Permissions [Opens in a new window]

Abstract

In this communication, we report an acute leukemia patient who developed conversion disorder mimicking the adverse effects of high-dose cytosine arabinoside (Ara-C) treatment after the patient received high-dose Ara-C treatment.

A 21-year-old woman, with acute recurrent leukemia after bone marrow transplantation, received high-dose Ara-C treatment and 10 days later was referred for psychiatric consultation because of an abrupt onset of convulsion. On neurologic examination, she showed convulsion of all the limbs without loss of consciousness. All limbs looked paretic; however, tendon reflexes in all limbs were normal and pathological reflex was not recognized. When her hand was dropped onto her own face, it fell next to her face but not on her face. Laboratory data were unremarkable. She had no history of psychiatric illness or drug or alcohol abuse.

The patient explained that she knew about the recurrence of her own leukemia and the news of the death of a close friend due to leukemia at the same time, which was a shocking event for her, focusing her attention on her own fears of dying from the same disease.

Conversion disorder in cancer patients is not common; however, appropriate diagnosis is very important to avoid inappropriate examinations and treatments.

In leukemia patients receiving chemotherapy, various kinds of signs and symptoms may develop due to the adverse effects of chemotherapy and/or infection. Therefore, conversion disorder might be overlooked and inappropriate treatment and examinations might be performed. Clinicians should consider conversion disorder in the differential diagnosis when patients develop unexplained neurological symptoms.

Keywords

Conversion disorderCancerPsychological distressHigh dose Ara-CBone marrow transplantation
Type
CASE REPORT
Information
Palliative & Supportive Care , Volume 2 , Issue 1 , March 2004 , pp. 79 - 82
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press.
Cole, N. & Gibson, B.E. (1997). High-dose cytocine arabinoside in the treatment of acute myeloid leukemia. Blood Reviews, 11, 39–45.Google Scholar
Damon, L.E., Mass, R., & Linker, C.A. (1989). The association between high-dose cytarabine neurotoxicity and renal insufficiency. Journal of Clinical Oncology, 7, 1563–1568.Google Scholar
Hughes, J. (1986). Denial in cancer patients. In Coping with Cancer Stress, Stoll, B.A. (ed.), pp. 63–69. Dordrecht, Boston, Lancaster: Martinus Nijhoff Publishers.
Hwang, T.L., Yung, W.K., Estey, & E.H., et al. (1985). Central nervous system toxicity with high-dose Ara-C. Neurology, 35, 1475–1479.Google Scholar
Kaplan, H.I. & Sadock, B.J. (1995). Somatoform disorders. Textbook of psychiatry. 6th ed. Philadelphia: Williams & Wilkins.
Nand, S., Messmore, H.L., Jr., Patel, & R., et al. (1986). Neurotoxicity associated with systemic high-dose cytosine arabinoside. Journal of Clinical Oncology, 4, 571–575.Google Scholar
Northouse, L.L., Dorris, G., & Charron-Moore, C. (1995). Factors affecting couples' adjustment to recurrent breast cancer. Social Science and Medicine, 41, 69–76.Google Scholar
Onishi, H., Miyashita, A., & Kosaka, K. (2000). Manic episode associated with bereavement in a patient with lung cancer. Supportive Care in Cancer, 8, 339–340.Google Scholar
Onishi, H., Onose, M., Yamada, & T., et al. (2003). Brief psychotic disorder associated with bereavement in a patient with terminal stage uterine cervical cancer: A case report and review of the literature. Supportive Care in Cancer, 11, 491–493.Google Scholar
Stiefel, F. & Razavi, D. (1994). Common psychiatric disorders in cancer patients. II. Anxiety and acute confusional state. Supportive Care in Cancer, 4, 233–237.Google Scholar
Sullivan, K.M., Agura, E., Anasetti, & C., et al. (1991). Chronic graft-verus-host disease and other late complications after marrow transplantation. Seminars in Hematology, 28, 250–259.Google Scholar
Thomassen, R., van Hemert, A.M., Huyse, & F.J., et al. (2003). Somatoform disorders in consultation-liaison psychiatry: A comparison with other mental disorders. General Hospital Psychiatry, 25, 8–13.Google Scholar