Secondary Psychosis Following Neoadjuvant AC-T Chemotherapy for Triple-Negative Breast Cancer: Case Report and Literature Review of Psychosis Postchemotherapy

Abstract

Triple-negative breast cancer is a unique subtype among breast cancers. Management includes a neoadjuvant chemotherapy regimen. Psychiatric complications of the regimen have not been reported before. We present a case of acute psychosis after the second cycle of chemotherapy in a 42-year-old woman with triple-negative breast cancer. The patient presented with sudden irritability, agitation, disorganization in speech and behavior, and paranoia involving her coworkers conspiring against her and causing her trouble with the law for 4 days. She was in her usual state of health until after her second cycle of chemotherapy. This was the first presentation of psychotic symptoms in her life. She was conscious and oriented. There were no neurologic deficits. She denied any change in her mood and any features of hallucinations. She was uncooperative, restless, had flight of ideas, and persecutory delusions. The remainder of the examination was normal. An autoimmune process, nervous system infection, or psychosis secondary to the chemotherapy were suspected. Serum electrolytes and other biochemical parameters were normal. Imaging of the brain showed no signs of acute brain insults or intracranial metastasis. Cerebrospinal fluid analysis and culture showed no abnormality or growth. The work-up revealed that neurologic, infectious, or autoimmune causes of her psychotic symptoms were less likely. Thus, a diagnosis of psychosis secondary to chemotherapy was considered. Treatment was with paliperidone, risperidone, clonazepam, and sertraline. Over the course of treatment, she showed substantial improvement and completed all of the chemotherapy sessions without adverse effects. In summary, we report a case of a patient whose initial chemotherapy course was complicated by psychosis. Since the neurotoxic and psychiatric effects of chemotherapeutics are not yet sufficiently elucidated, our case emphasizes that early signs of behavioral changes in patients receiving chemotherapy should trigger comprehensive psychiatric evaluation and monitoring of the patient’s mental state.

Mental Disorders Among Adolescents and Young Adults With Cancer: A Canadian Population–Based and Sibling Cohort Study

“…51 Elevated risk of psychotic disorders immediately postcancer diagnosis can be related to severe stress causing the unfolding of an underlying psychotic illness, advanced stage of cancer, cancer treatments, and medications. 52,53 Since psychotic illness can be distressing for patients and their families and associated with increased cancer-specific mortality, medical teams caring for these patients should be equipped with the tools for early detection and management. [52][53][54] Although the sibling cohort analysis showed statistically significant associations of cancer diagnosis with mental disorders only during the first 6 months postcancer diagnosis, magnitude and pattern of these effects were similar to those seen in analysis using the population-based cohort.…”

“…51 Elevated risk of psychotic disorders immediately postcancer diagnosis can be related to severe stress causing the unfolding of an underlying psychotic illness, advanced stage of cancer, cancer treatments, and medications. 52,53 Since psychotic illness can be distressing for patients and their families and associated with increased cancer-specific mortality, medical teams caring for these patients should be equipped with the tools for early detection and management. 52-54…”

The Emergence of a Psychotic Disorder With a Diagnosis of Breast Cancer Metastasized to the Brain: A Case Report

“…Again, psychotic state secondary to chemotherapy was reported in a patient with invasive ductal breast carcinoma. In this female patient, in addition to the explanation that antipsychotic treatment was started late, it was reported that paliperidone was started when no benefit was seen from olanzapine and risperidone and that the patient benefited and this drug was used during chemotherapy [ 12 ]. Since antipsychotic treatment in schizophrenia patients leads to significant differences in inflammatory gene expression and chronic inflammatory responses help cell mutation and cancer development [ 13 ], it is thought that breast cancer is more likely to occur in these patients [ 14 ].…”

“…The patient partially responded to the questions and a brain tomography revealed a 5.5 cm cystic space-occupying lesion in the right occipitotemporal region with edema around it (Figure 2). Hemoglobin: 4 g/dL (12)(13)(14)(15)(16), white blood cell: 12000 (3.6-11.000), glucose: 71 mg/dL (74-100), albumin: 15 g/DI (15-52), total protein: 50 G/dL(66-83), lactate dehydrogenase: 336 U/L(125-248), C reactive protein: 75 mg/dL (<8) other parameters were within normal range. The patient was hospitalized in the general internal medicine intensive care unit to determine the etiology of general condition disorder, anemia, high infectious value, and masses in the breast and brain.…”

Quetiapine Moderates Doxorubicin-Induced Cognitive Deficits: Influence of Oxidative Stress, Neuroinflammation, and Cellular Apoptosis

“…Sci. 2023, 24, 11525 2 of 17 psychological symptoms such as being overly talkative, irritable mood, insomnia, high self-esteem, and hyperreligiosity have been reported in some patients after chemotherapy treatments [3]. Crosstalk exists between psychotic symptoms and the experience of cognitive impairment.…”