Załuska Maria, Janota Bertrand, Papierska Lucyna
IV Klinika Psychiatrii IPiN w Warszawie, Cegłowska.
Psychiatr Pol. 2006 Nov-Dec;40(6):1149-60.
To broaden the knowledge about somatic mechanisms of psychic disturbances.
Presentation of a 54 year old male with psychic disturbances and hyponatremia.
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.
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.
拓宽对精神障碍躯体机制的认识。
介绍一名患有精神障碍和低钠血症的54岁男性病例。
在经历了六个月的头痛、恶心、疲惫、易怒、缺乏动力和食欲后，急性精神障碍突然发作。这些反复发作的症状包括激动、攻击性、妄想、幻觉，有时还伴有定向障碍和记忆丧失；与低钠血症（血钠104 - 118 mEq/L）同时出现；被归类为器质性妄想障碍，（出现定向障碍和记忆丧失时）归类为谵妄（ICD - 10中的F06.2，F05）。症状持续了6个月，被归类为脑功能障碍所致人格障碍（ICD - 10中的F07.8）。急性精神障碍两次中断了内科病房的住院治疗，并导致三次精神科住院；直到在不适当抗利尿激素分泌综合征（SIADH）过程中诊断出低钠血症，病因是左肺小细胞癌。
伴有低钠血症的SIADH综合征和多形性精神障碍在左肺小细胞癌隐匿发展的临床和影像学表现之前已经存在很长时间。在综合医院精神科病房进行合法的非自愿住院，并能方便地进行专门的实验室检查和会诊，有助于确立诊断。限制水摄入并口服补充盐分使精神状态稳定，并得以在肿瘤研究所进行治疗。该病例说明了精神障碍复杂的躯体机制以及精神科与其他医学学科交界领域多专科合作的必要性。
