The aim is to emphasize the clinical challenges associated with patient’s relative interference with clinical management. This is the first report in the department of a total laryngectomee developing depressive psychosis.

A 70 year-old male with 2years history of unremitting hoarseness and difficulty in breathing of 2months duration. He took alcohol for 34years, did not smoke, was not a known hypertensive but had elevated blood pressure. He was stridulous. Laryngoscopy showed warty supraglottic mass. Assessment of upper airway obstruction secondary to laryngeal tumour was made. He had Emergency tracheostomy, Direct Laryngoscopy (DL) and Biopsy. Findings were normal trachea, warty growth from glottic to supra-glottic region. Histology was well differentiated invasive squamous cell carcinoma. Computed Tomographic (CT) Scan of Larynx was normal. He declined Total Laryngectomy. DL and biopsy was repeated and histology was severe laryngeal dysplasia. Patient and relatives doubted the result. DL and Biopsy was redone. Histology reported well differentiated keratinizing squamous cell carcinoma. A repeat CT Scan of Larynx showed laryngeal tumour. He had total laryngectomy. Findings were Transglottic fleshy tumour invading the tracheal rings. He developed pharyngocutaneous fistula, managed conservatively. He exhibited abnormal stereotyped movements, insomnia, refusal of meals, aggressiveness and violent tendencies. Mental health team placed him on Haloperidol, then Fluoxetine and frequent visitations. He had series of depressive symptoms, which improved on Risperidone.

Depressive psychosis in a laryngectomee is a major medical concern which needs appropriate management to improve patient’s quality of life.

Keywords: Total laryngectomy, Depression, Psychosis.