Purpose: We report a case of delirium and convulsion after administration of olanzapine in a cancer patient with refractory vomiting. Case report: The patient was a male in his 70s who suffered from lung cancer. After chemotherapy, olanzapine was used for refractory nausea and vomiting. Since this treatment, the patient has experienced delirium and convulsions. While we modified some reversible causes of the delirium, the delirium did not improve. Discontinuation of olanzapine resulted in improvement of the delirium. Recurrent convulsions did not occur with sodium valproate. Olanzapine might increase the risk of delirium and convulsions.

Background: Mental assessment for patients in a palliative care unit with no regular psychiatrist tends to depend on subjective judgments by other health professionals. We introduced the 9-item Patient Health Questionnaire (PHQ-9) to screen major depression from patients in a palliative care unit and assessed the usefulness of the questionnaire. Methods: The subjects were all patients who were admitted to a palliative care unit. Each patient was asked to answer the PHQ-9 on admission and then was interviewed by a psychiatrist. When PHQ-9 score was of 10 points and above, the case was judged to be positive for depressive disorder. A psychiatrist diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). Results: A total of 83 patients were hospitalized between January 2016 and October 2016. 50 patients completed PHQ-9 and psychiatrist’s interview. Nine cases were positive by PHQ-9 and diagnosed as depressive disorder by a psychiatrist. Seven cases were positive by the PHQ-9 but not diagnosed as depressive disorder. Although 34 cases were judged to be negative by the PHQ-9, 2 cases of them were diagnosed as depressive disorder. The sensitivity and specificity of the PHQ-9 were 81.8% and 82.1% respectively. Conclusion: We found that the PHQ-9 was useful screening test for depression even in palliative care settings.