A man in his seventies, suffering from bipolar I disorder since he was in his thirties, was admitted to our hospital for his manic state. Shortly after admission, he transitioned into a severe depressive state. During his hospitalization, he was diagnosed with stage IV hypopharyngeal carcinoma. The otorhinolaryngologist recommended initiating radiation therapy as soon as possible. However, due to severe depressive symptoms, the patient could not be informed about his diagnosis and couldn't give his consent to the treatment. Therefore, with his family's consent, five sessions of modified electroconvulsive therapy (mECT) were performed. In addition to the hypopharyngeal carcinoma, the patient was also diagnosed with a polymorphous adenoma in the parapharyngeal space. Intubation was therefore thought to be difficult in case of emergency. We collaborated with otorhinolaryngologists to prepare for an emergency tracheostomy during mECT. After his depressive symptoms alleviated, radiotherapy for hypopharyngeal carcinoma was performed with the patient's informed consent and cooperation. This study demonstrates that it is useful to use mECT for quick alleviation of depression when cancer treatment cannot proceed due to depressive symptoms. It also shows that general hospital psychiatry plays a significant role in cases where patients have both severe mental and physical illness.
Authors' abstract
A Case with Severe Depression in Bipolar I Disorder, Stage IV Hypopharyngeal Carcinoma, and Difficult Intubation, that was Treated with Modified Electroconvulsive Therapy through Multidisciplinary Collaboration: Patient Rights Protection and the Role of Psychiatry in General Hospitals
1 Department of Neuropsychiatry, The University of Tokyo Hospital
2 Department of Psychiatry, Tama Aoba Hospital
3 Department of Psychiatry, Toranomon Hospital
4 Department of Neuropsychiatry, NTT Medical Center Tokyo
5 Disablility Services Office, The University of Tokyo
6 Anesthesiology and Pain Relief Center, The University of Tokyo Hospital
7 Department of Radiology, The University of Tokyo Hospital
8 Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
9 Department of Pain Medicine, Fukushima Medical University School of Medicine
2 Department of Psychiatry, Tama Aoba Hospital
3 Department of Psychiatry, Toranomon Hospital
4 Department of Neuropsychiatry, NTT Medical Center Tokyo
5 Disablility Services Office, The University of Tokyo
6 Anesthesiology and Pain Relief Center, The University of Tokyo Hospital
7 Department of Radiology, The University of Tokyo Hospital
8 Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
9 Department of Pain Medicine, Fukushima Medical University School of Medicine
Psychiatria et Neurologia Japonica
124: 439-446, 2022
Accepted in revised form: 6 April 2022.
Accepted in revised form: 6 April 2022.
＜Keywords：bipolar disorder, multidisciplinary collaboration, electroconvulsive therapy, radiation therapy, pharyngeal neoplasms＞
