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Is it Drug-Related Akathisia, or Anxiety? A Diagnostic Dilemma

Is it Drug-Related Akathisia, or Anxiety? A Diagnostic Dilemma

A 50-year-old man with multiple hospitalizations for chemotherapy
for recurrent germ-cell carcinoma was admitted for nadir fever.
A psychiatric consultation was requested for evaluation of anxiety
and depression.

The patient described having a sad mood, with mild anxiety and
weakness, whenever he was admitted for chemotherapy, and said
that the mood would last until he regained his strength in the
period following treatment. He also complained of nausea, vomiting,
decreased energy, and an inability to feel pleasure (anhedonia)
since the time of admission, 4 days earlier.

The patient's psychiatric history included use of cocaine and
marijuana until 5 years previously when he was diagnosed with
his cancer. He noted that these illicit drugs helped him relax
and feel more alive. Otherwise, he had no formal psychiatric history.

His current medications included hydrocortisone for metabolic
abnormalities, and lorazepam and prochlorpera-zine as needed for
anxiety and nausea, respectively. Laboratory tests were significant
for nadir blood count (WBC, 0.1; Hgb, 6; Hct, 15.5; platelets,
42,000) and slight hyponatremia (128; normal range, 136 to 144).

The patient was mildly anxious during the interview. He was cooperative
and did not display significant psychomotor agitation. He spoke
sadly of having to acquiesce and accept a home health aide upon
discharge, assistance that he had refused previously. He stated
that he felt considerable relief from being able to talk about
his changing life circumstances during the interview.

Adjustment Disorder Diagnosed

The patient was diagnosed with an adjustment disorder with mixed
emotional features (anxiety and depression). Recommendations included
supportive psychiatric follow-up as needed and a social work consult
to help him with home assistance. The patient did not feel that
regular psychiatric follow-up was necessary.

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