COMPLICATIONS AFTER THE TREATMENT OF LARYNGEAL CANCER IN A PARANOID SCHIZOPHRENIA PATIENT

Background:The aim of the work is the present an analysis of the diagnostic-treatment process in a psychologically disturbed patient with a deteriorating somatic state as well as showing the possibility for communication with this patient despite the difficulties in verbal means of the said. Case study:A 65-year old patient, a bachelor with secondary education, had been treated for paranoid schizophrenia ( acc. ICD 10) since he was 38 years old. He had been hospitalized in psychiatry wards many times. From the age of 48 he was housed in a residential medical care facility. The medical personnel noticed disturbances in the process of swallowing, bleeding from the mouth as well as attempts at mechanically passing the foods given through the throat. The patient did not report or confirm the presence of any symptoms whatsoever. The patient was diagnosed as having laryngeal cancer. As a result of the patient's poor psychiatric state and the inability for close cooperation to be conducted in the post-operational period the patient was disqualified from surgical and radiological treatment. The patient was administered a tracheotomy tube, which he removed repeatedly while attempts at replacing the tube induced the patient's active verbal and physical aggression. From the very beginning of his stay in the unit verbal contact with the patient had been difficult. He often resorted to non-verbal communication ( facial grimaces, nodding his head, waving his hand). Following the diagnosis of the cancer there was observed in the patient an intensification in behavioural disturbances ( self aggression, verbal and physical aggression). Tracheotomy made the verbal communication process worse and resulted in the appearance of features of a depression syndrome. Throughout the duration of the cancer treatment of the throat anti-psychotic treatment was continued in addition to the implementation of systematic psycho-education, despite a lack of interest on the part of the patient. Conclusions:It can be concluded, on the basis of the case described above, that the early detection and administration of an effective treatment that would offer hope for a cure of a malignant tumour are very difficult in patients with severe mental disorders. The authors' application of the AIS is innovative. Its use has helped to demonstrate that continuous psychotherapeutic and rehabilitation efforts ( and the associated determination and commitment of staff) have a significant effect on illness acceptance and the process of cancer treatment even in individuals with mental disorders. A higher level of self-acceptance of a mental condition contributes to an improvement in the evaluation of a treatment administered. Modifying the pharmacotherapy of a mental disorder may become an important factor in improving cooperation with and the self-appraisal of a patient. A tracheotomy tube may impede interpersonal communication in chronic schizophrenia patients with a prevalence of adverse symptoms.