SUMMARYA 25-year-old Thai woman with ovarian germ cell tumour presented with behavioural changes after receiving an intensive dose of neoadjuvant chemotherapy with bleomycin, etoposide and cisplatin, for a relapse. Her initial symptoms of mood fluctuation and insomnia were noticed while hospitalised for the third cycle, and became more severe. She was very irritable, highly distracted and forgetful. She exhibited flights of ideas and hyperactivity, including compulsive shopping. She also had paranoid ideations, auditory hallucinations, and thoughts of being wealthy and close to the prime minister. She was not depressed. She was diagnosed with axis I psychotic disorder not otherwise specified. The incremental dosage of olanzapine from 5 to 20 mg/day was given but failed to control her psychotic symptoms during the first week, and was therefore switched to risperidone. At 4 mg/day, her symptoms were dramatically controlled. This novel evidence suggests the rare possibility of an association between chemotherapy and the development of psychotic attacks.
BACKGROUND
Alzheimer's disease is the most common cause of dementia in older adults. The clinical features include progressive memory decline as well as cognitive deficits with executive dysfunction, language, visual perceptual difficulties, apraxia and agnosia. During the moderate to severe stage of the disease, there is a major decline in memory and function, while neuropsychiatric disturbances often emerge and patients become difficult to manage. These distressing symptoms increase caregiver burden and add to the direct costs of care of the patients. Any improvements in patient function and behavioral symptoms can reduce caregiver burden. Memantine has been available for a number of years in Europe and in North America. In this article, we examine the pharmacological rationale for its use, and the current clinical evidence for its efficacy and long-term effectiveness in the management of cognitive and behavioral symptoms in moderate to severe stages of Alzheimer's disease.
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