Newly diagnosed mania in a patient with stage IV pancreatic adenocarcinoma: A case report

Brauner, Gabrielle; Cove, Alexander; Li, Jialin; Bronson, Brian; Chacko, Mason

doi:10.1016/j.psycr.2022.100071

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…In the literature, different previously published cases reported new-onset mania observed as the initial symptom of pancreatic cancer, despite the lack of a known causal relationship (Murru et al , 2009; Basterreche et al , 2017; Brauner et al , 2022; Pereira et al , 2022). In all these cases, the patients were mature individuals in whom space-occupying masses were ruled out, and there were no relevant personal or family psychiatric histories.…”

Section: Discussionmentioning

confidence: 99%

Manic episode in a patient with pancreatic adenocarcinoma: a case report

Mena,

Andreu,

Giménez-Palomo

et al. 2023

International Clinical Psychopharmacology

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Psychiatric comorbidity is common in cancer patients, emphasizing the need for comprehensive care. While depressive symptoms in pancreatic cancer have been studied, there is limited attention given to manic symptoms. This case report aims to contribute to the knowledge of pancreatic cancer psychiatric comorbidities by describing a case of a patient with stage IV pancreatic cancer who presented a sudden onset manic episode. The patient, a 61-year-old male with stage IV pancreatic cancer, presented at the Emergency Room with abrupt behavioural changes suggestive of a manic episode of 2 weeks of evolution. The patient had been undergoing chemotherapy and short 3-day cycles of corticosteroids for the past 9 months but had been off this treatment for 20 days when the episode began. Acute organic causes were ruled out. The patient was admitted to the psychiatric unit, where organic screening was expanded and treatment with antipsychotics and a mood stabiliser was initiated with subsequent remission of symptoms after 2 weeks. This case shows a manic episode as a rare psychiatric complication in pancreatic cancer. In the literature reviewed, four other similar cases have been observed. Further research is needed to elucidate the underlying pathophysiology and explore possible treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Manic episode in a patient with pancreatic adenocarcinoma: a case report

Mena,

Andreu,

Giménez-Palomo

et al. 2023

International Clinical Psychopharmacology

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“…There have been numerous case reports of one particular class chemotherapy drugs, Folfirinox and its predecessor Folfiri, eliciting psychotic features in patients [159][160][161][162][163][164], including mania with delusions [162] or, in some cases, triggering only visual or auditory hallucinations [165,166]. Folfirinox is a combination of folinic acid, 5-fluorouracil (5-FU), irinotecan and oxaliplatin.…”

Section: Dysregulation Of the Folate Cycle With Psychosis: Treating C...mentioning

confidence: 99%

Diverse avenues of research support the transmethylation theory of psychosis: implications for neuroprotection

Miller

2024

Explor Neuroprot Ther

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Transmethylation in the context of psychiatry has historically referred to the enzymatic transfer of a methyl group from one biochemical to another, whose resulting function can change so dramatically that a biochemical like tryptamine, for example, is converted into the hallucinogen dimethyltryptamine. Central to endogenous methylation activity is the folate cycle, which generates the primary transferable methyl groups in mammalian biochemistry. The relevance of this cycle to mental health becomes clear when the cycle is dysregulated, often leading to a buildup of both homocysteine and S-adenosylhomocysteine (SAH), while accompanied by a transient reduction in the intended physiologic target, S-adenosylmethionine (SAM). This paper includes an in-depth review of the causes of folate cycle perturbations associated with psychotic symptoms, expounding on alternative downstream pathways which are activated and pointing toward potential etiologic agents of the associated psychosis, the methylated tertiary amines N-methyl-salsolinol, N-methyl-norsalsolinol, and adrenochrome, which appear in scientific reports concerning their association with hallucinogenic and/or neurotoxic outcomes. Electrotopological state (E-state) data has been generated for these compounds, illustrating a strong similarity with hallucinogens, particularly in terms of the E-state of the nitrogen in their tertiary amine moieties. In light of the role the folate cycle plays in transmethylation, neuroprotective strategies to prevent the transition to psychosis are suggested, including the advisory that folate supplementation can be harmful depending on the status of other relevant biochemicals.

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Newly diagnosed mania in a patient with stage IV pancreatic adenocarcinoma: A case report

Cited by 2 publications

References 13 publications

Manic episode in a patient with pancreatic adenocarcinoma: a case report

Manic episode in a patient with pancreatic adenocarcinoma: a case report

Diverse avenues of research support the transmethylation theory of psychosis: implications for neuroprotection

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