Organic Psychosis due to Lung Cancer Metastasis Accompanied by Severe Psychiatric Symptoms Treated With Blonanserin Transdermal Patch: A Case Report and Literature Review.

backgroundOrganic psychosis associated with brain metastasis from cancer occasionally presents with psychiatric symptoms such as delusions or violent behavior. In these cases, however, psychotropics may not be sufficiently effective, and their continuous use may also be difficult due to side effects. Besides, regular oral administration of psychotropics becomes more difficult when medication refusal develops. CASE PRESENTATION: A man in his 80s. At X-1 years, lung cancer was found to have metastasized to the right frontal lobe, with no apparent psychiatric symptoms. At X years, however, the patient was hospitalized because of consciousness disturbance, and new brain metastases in the right parietal and occipital lobes were detected. Irritability, violent behaviors, and delusions became dominant and required physical restraint. Refusal to take oral medications was also noted. Blonanserin transdermal patch (40 mg/day) was started along with an intravenous drip of haloperidol, and he became mentally calm, although psychiatric symptoms persisted with fluctuations. His mental status was finally stabilized with blonanserin transdermal patch (80 mg/day) with no side effects, leading to hospital discharge on Day 53 after admission.

conclusionsBlonanserin transdermal patch may be effective for organic psychosis associated with brain metastasis. Because it can be used in cases where oral medication is difficult and has relatively few side effects, such as hypotension and extrapyramidal symptoms, it may be a helpful option for oncologists and liaison psychiatrists.