Abstract
Tow cases of malignancy preceded by depressive symptoms were reported. Case 1 : Carcinoma of the pancreas. A 57-year-old man developed depressive symptoms associated with epigastralgis, and was referred to us for psychiatric consultation. One month prior to hospitalization a series of extensive medical examinations were conducted. Fasting blood sugar examination, gastrointestinal X-ray series and hypotonic-duodenography were all unremarkable, but 50g GTT showed a diabetic pattern. Therefore, diabetes mellitus was controlled with diet. There was little abatement of his depressive symptoms as well as the abdominal and back pain despite various medication. He continued to lose weight. Scintigram of the pancreas was preformed 20 days before his death, revealing a defect of the tail. Celiac angiography revealed encasement and irregularity of the splenic arteries suggesting the presence of a carcinomatous lesion of the pancreas. Microscopic examination of biopsy specimens of the tumor of the skin confirmed metastatic adenocarcinoma. Eleven months after onset of depressive symptoms, the patient died of carcinomatous effusion of the thorax. Case 2 : Carcinoma of the bile duct. A 68-year-old developed depressive symptoms such as poor appetite, insomnia and loss of ambition, and he was diagnosed as depression. Four months after the onset of depressive symptoms, he developed jaundice, which was diagnosed as obstructive jaundice. Percutaneus transhepatic cholangiography revealed complete obstruction of the bile duct, indicating carcinoma of the bile duct. Cytological examination of the bile found adenocarcinoma. Since depressive symptoms continued even after improvement of jaundice, the patient was referred to psychiatric consultation and diagnosed as depressive associated with malignancy. Patient was discharged after fistel construction. Even though the relationship between depression and malignancy has been emphasized ub a number of studies, medical illness was so often overlooked in the psychiatric patient. We discussed in this paper the features of depressive symptoms of our cases, the relationship between depression and malignancy and importance of medical evaluation of patients with psychiatric symptoms. Some psychiatric conditions, depression and hypochondria in particular, require thorough medical evaluation, as psychiatric treatment of these conditions offers no solution to other physical illness.
