Alexandrine Syndrome and Palliative Care: A Psychotic Reaction against Death: A Case Report

Abstract

Background: Palliative care disclosure and death-facing can be traumatic for patients with advanced cancer. Some of them can suffer a psychotic breakdown that must be differentiated from a terminal delirium. Objectives: To describe a psychiatric side effect from a palliative care announcement called the Alexandrine syndrome. Methods: To illustrate this, we report the case of a patient with no past psychiatric history who, a few days after his palliative state has been announced, presented a major behavioral disorder with violence and paranoiac delusions, heteroagressivity against caregivers and autoagressivity, that could not be explained by a somatic origin. Results: With this case report, we would like to point out the importance of an unreported palliative clinical situation which cannot be explained by an organic substratum. An intense fear of death expressed by the patient with an outburst of defense mechanisms can lead to a brief psychiatric decompensation without any preexisting state of psychosis. Conclusion: The hypothesis of an Alexandrine syndrome should be considered in palliative care in advanced cancer patients experiencing massive anxiety when facing death. This infrequent diagnosis should especially be hypothesized when a patient presents a feature with sudden or recent profound mental disorder following an oncologist consultation with palliative state disclosure. Physical and psychological consequences must not be neglected for patients, as well as disturbing occurrences for the medical team involved. Therefore, oncologists and palliative doctors should be aware of this possibility. Collaboration between psychiatrists and palliative and oncologic teams is recommended to better manage this psychiatric situation.