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In 2013 more than 150,000 Americans died from all types of lung cancer. Small cell lung cancer (SCLC) represents about 13% of all lung cancers and is notoriously associated with paraneoplastic syndromes (PNS). Here we present an interesting case of psychosis associated with one such PNS-- ectopic Cushing syndrome of SCLC. A 56 year old African-American male with no prior psychiatric history who was diagnosed with SCLC two months prior, presented to the ER for treatment of a right arm laceration he sustained while fighting off attackers, with high concern these individuals may have been part of hallucinatory experiences and well-systematized persecutory delusions regarding his wife. Physical assessment was notable for Cushingoid symptoms. Initial results of serum ACTH and cortisol were 221pg/ml (10-50pg/ml) and 37.1 mcg/dl (10-20mcg/dl) respectively. For psychosis, patient was started on Olanzapine which was titrated from 5 to final dose of 10mg nightly. Since patient was not a surgical candidate, he was treated with metyrapone 250 mg BID and radiation therapy was continued throughout hospitalization. Serum Cortisol level decreased steadily after initiation of metyrapone and psychotic symptoms dramatically reduced on olanzapine, metyrapone, and radiation therapy with apparently resolved persecutory delusions at discharge. This case broadens the available literature and provides data on successful symptomatic treatment with olanzapine while biological treatments of the underlying condition were beginning to take effect. As SCLC remains an important cause of morbidity and mortality in the US, it is imperative that physicians be aware of paraneoplastic syndromes and their psychiatric sequelae.

The American Heart Association has a national network of community-based programs designed to reduce response times to cardiac emergencies by improving access to automatic external defibrillators (AEDs) among laypersons. Success of these Operation Heartbeat programs depends in part on the public's knowledge of the warning signs of a myocardial infarction (MI) and appropriate response to cardiac arrest victims. In May 2000, a 7-minute telephone survey was administered to a random sample of adults residing within the American Heart Association affiliate territories of New York, New Jersey, and Connecticut to determine the knowledge of MI symptoms, confidence in cardiopulmonary resuscitation (CPR) use, and the awareness of AEDs. Of the respondents, 60% were women (n=1,128), 83% were Caucasians (n=1,558), 15.2% were non-whites (African American, Asian, or Hispanic), and 38.5% had at least a college degree (n=724). Women were significantly more likely than men to know that sex differences exist in the warning signs for an MI (63% vs. 30.7%, respectively; P< .001). Whites had above-average confidence in MI recognition compared with non-whites (39.2% vs. 27.4%, respectively; P< .001) and were more cognizant of the public availability of AEDs (54.5% vs. 33.2%, respectively; P< .001). Our findings suggest that racial/ethnic and sex disparities exist in the awareness of AEDs and in the knowledge of atypical MI symptoms in women, respectively. Innovative CPR outreach programs might be needed in New York area communities to increase CPR training among all adults, to increase AED awareness in vulnerable populations, and to improve knowledge and confidence in the recognition of acute MI symptoms.