Temporary loss of moral behavior in a patient undergoing chemotherapy with cisplatin - breaking bad

Abstract

BackgroundBehavioral disturbances following chemotherapy with cisplatin are rare. Here, we report a patient with temporary loss of moral behavior in the setting of cisplatin-based chemotherapy for treatment of tonsillar cancer.Case presentationA 66-year-old Caucasian male with no psychiatric or violent history was started on chemotherapy with cisplatin for treatment of tonsillar cancer. During the following weeks, the patient developed profound personality changes involving volatile emotions and impulsive aggression with verbal and physical assaults on others. Admitted to the hospital, the patient lacked any awareness that his behavior was wrong. Chemotherapy was discontinued and the patient was prescribed risperidone. Aside from mild cognitive impairment, comprehensive neuropsychological, neuroradiological and lab testing were unremarkable. Three weeks following cessation of chemotherapy, the patient had recovered to his original mental state and he was completely aware of his wrongdoing and social misconduct.ConclusionSince neurotoxic effects of chemotherapeutics on the brain are not yet sufficiently elucidated, our case emphasizes that early signs of behavioral abnormalities in patients receiving chemotherapy should trigger comprehensive psychiatric evaluation and ongoing monitoring of the patients’ mental state.

Inhibition of the CSF‐1 receptor sensitizes ovarian cancer cells to cisplatin

“…Several reports have shown that cisplatin resistance appears mainly through faults in the apoptosis pathway as well as alteration in cisplatin aggregation in cells. It was reported that DNA injury caused by cisplatin stimulates phosphorylation of Bcl‐2‐related agonist of cell death by ERK and PI3K/AKT signalling pathways . Phosphorylation of Bcl‐2‐related agonist of cell death is indispensable to the viability of cisplatin‐resistance cells .…”

“…It was reported that DNA injury caused by cisplatin stimulates phosphorylation of Bcl-2-related agonist of cell death by ERK and PI3K/AKT signalling pathways. 26,27 Phosphorylation of Bcl-2-related agonist of cell death is indispensable to the viability of cisplatin-resistance cells. 28 Suppression of either pathway may enhance cisplatin sensitivity of a number of tumour cells.…”

Cisplatin-induced change in moral conscience and behaviour

“…It was not until the patient's behaviour improved that cisplatin was suspected as being responsible for the symptoms. 8 The outcome of this case was positive, with the patient seeing a full return to his normal function. However, it seems that the patient's aggressive behaviour was the main reason cisplatin treatment was stopped.…”

“…7 However, a recently reported case by Barlinn et al suggested that cisplatin may in fact be able to cause CNS impairment in rare cases, and may have been responsible for major neurological and behavioural changes in a man undergoing cisplatin treatment for tonsillar cancer. 8…”

Challenges in Treating Cancer Patients With Unstable Psychiatric Disorder

“…After readjustment of antipsychotic therapy, symptoms subsided within 15 days. Table 2 [17,[81][82][83][84][85][86][87][88][89] summarizes chemotherapeutic agents associated with similar presentations.…”