Acute Psychosis in an Adolescent Girl During Treatment for Advanced Nodular Lymphocyte-Predominant Hodgkin's Lymphom

Abstract

A 16,5 year old female adolescent was diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma (nLPHL), presenting bilateral inguinal and right iliac lymphadenopathy accompanied by B-symptoms. The patient was due to treatment according to the German Interim Guidelines of HD 2002-Pilot Study with 2x OPPA (vincristine, adriamycine, prednisone, procarbacine) and 2x COPP (cyclophosphamide, vincristine, prednisone, procarbazine) and radiotherapy. After 2x OPPA the patient presented a severe episode of a presumably prednisone-induced acute psychosis with need for psychiatric treatment and change of therapy regimen. She was successfully treated with a chimeric monoclonal anti-CD20 antibody (rituximab) and subsequent radiotherapy.

Psychiatric Adverse Effects of Pediatric Corticosteroid Use

“…After withdrawal of prednisone and procarbazine, she presented with paranoia and command hallucinations. 47 Although neither case can be definitively tied to prednisone use rather than to procarbazine use, the strength of the literature surrounding corticosteroid-associated psychosis in adults makes a compelling argument for contributions from the former.…”

“…41,48,58,77 However, if they were documented at all, psychiatric adverse events were sometimes delayed, emerging only after weeks of treatment 41,42,50 or even after cessation. 38,39,47 In those case studies documenting psychiatric reactions that began 1 to 11 days after corticosteroid administration was stopped, most reactions were characterized as psychosis; one case emphasized combativeness and emotional lability, and another described acute-onset obsessive-compulsive symptoms. 41,42,47,54,55,78 MANAGEMENT STRATEGIES In the event that children suffer corticosteroidinduced psychiatric reactions, the use of antipsychotic medications or benzodiazepines, alone or in combination, has proven helpful.…”

“…38,39,47 In those case studies documenting psychiatric reactions that began 1 to 11 days after corticosteroid administration was stopped, most reactions were characterized as psychosis; one case emphasized combativeness and emotional lability, and another described acute-onset obsessive-compulsive symptoms. 41,42,47,54,55,78 MANAGEMENT STRATEGIES In the event that children suffer corticosteroidinduced psychiatric reactions, the use of antipsychotic medications or benzodiazepines, alone or in combination, has proven helpful. In both adult and child populations, there is no consensus on the "best" pharmacotherapy to use.…”