Patients with co-existing cancer and mental illness are at increased risk for mortality due to many factors arising from their mental illness.

We present the case of a 32-year-old man with a known psychiatric history (schizoaffective disorder versus bipolar disorder versus delusional disorder) who has been non-medically treated since a young age. In May 2017, the patient presented with a mass (21 mm measured by an echography) in the left testicle, AFP 110 ug/L, bHCG 7300 Ul/L and LDH 204 U/L. A left orchidectomy was proposed but the patient refused on religious grounds. Two months later, the disease had progressed with appearance of enlarged retroperitoneal lymph nodes and lung nodules. The patient again refused all suggested treatments. Seven months later, the cancer was progressing with multi-organ involvement. The patient decided to be then treated with orchidectomy, demonstrating a mixed histology of 50 % choriocarcinoma and 50 % teratoma. We initiated treatment with bleomycin, etoposide and cisplatin and the patient received three cycles. The patient presented with severe fatigue with a performance status of three and was hospitalized. During the hospitalisation the patient developed an uncontrollable manic phase and was transferred to a psychiatric unit. Of note, the patient received corticosteroids and had an infection during his hospitalisation, both of which could havetriggered and exacerbated the pre-existing psychiatric illness. Together with many other factors associated with cancer, a hospitalisation can also cause a psychotic decompensation.

Corticosteroids, infections and emotional distress are all triggers for a psychotic decompensating of an underlying psychiatric disorder. Moreover, they are all frequently seen in an oncological setting, highlighting the need to create awareness when treating psychiatric patients in oncology wards. These patients are at increased risk of morbidity and mortality due to the complicated treatment courses, medication side effects and unexpected patient behaviour, hence the importance of a close psychiatric follow-up.