Reich Michel, Comet Benedicte, Le Rhun Emilie, Ramirez Carole
Psycho-oncology Team, Centre Oscar Lambret, Lille, France.
Department of Radiotherapy, Centre Oscar Lambret, Lille, France.
Palliat Support Care. 2012 Jun;10(2):135-9. doi: 10.1017/S1478951511000757. Epub 2012 Feb 24.
Brain tumors are classically associated with neurological and/or psychiatric symptomatology. Behavioral or cognitive disorders can underlie delirium, personality changes, psychotic reactions, and mood disorders.
To illustrate this, we report the case of a 60-year-old male patient confronted with an inoperable glioblastoma multiforme on the splenium of the corpus callosum, of poor prognosis, treated by concomitant radiochemotherapy with temozolomide, who developed psychotic depression with Cotard's syndrome. Clinical manifestations of this syndrome with untoward consequences in terms of prognosis are classically characterized by intense moral suffering, indignity and pessimistic fixations, suicidal ideations, and a nihilistic delusion relating to one's own body.
Nevertheless, this association between Cotard's syndrome and glioblastoma has been seldom described. To our knowledge, this is the first time that this has been described as a complication of this particular tumor location. Some neuropsychopathological hypotheses are proposed, which involve medical, iatrogenic, and psychogenesis issues.
This case report points to the necessary collaboration between psychiatrists, neuro-oncologists and radiation oncologists in improving the patient's management and quality of life.
脑肿瘤通常与神经和/或精神症状相关。行为或认知障碍可能是谵妄、人格改变、精神反应和情绪障碍的潜在原因。
为了说明这一点，我们报告了一例60岁男性患者，其患有一种无法手术的位于胼胝体压部的多形性胶质母细胞瘤，预后较差，接受了替莫唑胺同步放化疗，之后出现了伴有科塔尔综合征的精神病性抑郁。该综合征的临床表现对预后有不良影响，其典型特征为强烈的精神痛苦、屈辱感和悲观固执、自杀观念以及与自身身体有关的虚无妄想。
然而，科塔尔综合征与胶质母细胞瘤之间的这种关联很少被描述。据我们所知，这是首次将其描述为这种特定肿瘤部位的一种并发症。我们提出了一些神经心理病理学假设，涉及医学、医源性和心理发生问题。
本病例报告指出，精神科医生、神经肿瘤学家和放射肿瘤学家之间有必要开展合作，以改善患者的治疗和生活质量。
