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(Drug information on hydrocortisone) for metabolic abnormalities, and lorazepam(Drug information on 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.