World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://www.wjon.org

Review

Volume 000, Number 000, October 2021, pages 000-000

Challenges in Treating Cancer Patients With Unstable Psychiatric Disorder

Figures

Figure 1.
Figure 1. Molecular and cellular mechanisms underlying mood disturbances and psychosis in cancer patients (adapted from Watkins et al, 2014 [11]). 5-HT: serotonin; BDNF: brain-derived neurotrophic factor; CNS: central nervous system; C-RP, C-reactive protein; GSK3-β: glycogen synthase kinase 3 beta; IDO: indoindoleamine 2,3-dioxygenase; IL-1β: interleukin-1 beta; iNOS: inducible nitric oxide synthase; Map38: p38 mitogen-activated protein kinase; NFκB: nuclear factor kappa-light-chain-enhancer of activated B cells; RNS: reactive nitrogen species; ROS: reactive oxygen species; TNFα: tumor necrosis factor alpha.
Figure 2.
Figure 2. Potential analgetic properties of certain antipsychotic agents.

Tables

Table 1. Commonly Used Antipsychotics in Oncology Settings
 
Antipsychotic agentStarting dose (mg)SchedulingMaximum daily dose (mg)References
PO: orally; IM: intramuscularly; IV: intravenous; q12h: every 12 hours.
Quetiapine25 - 50 mg POQ12 - 24h800 mgSakamoto et al, 2020 [51]; Shinno et al, 2007 [52]; Verwimp-Hoeks et al, 2012 [53]
Olanzapine (Zydis)2.5 - 10 mg POQ12 - 24h20 mgSanomachi et al, 2017 [54]; Bitter et al, 2004 [55]; Breibart et al, 2002 [56]
Risperidone (M-Tab)0.25 - 2 mg POQ12h6 mgKishi et al, 2012 [57]; Reutfors et al, 2017 [58]
Chlorpromazine12.5 - 50 mg PO/IM/IVQ4 - 12h300 mgMcIver et al, 1994 [59]; Kamgar-Dayhoff et al, 2021 [60]; Csatary, 1972 [61]
Haloperidol0.25 - 1 mg PO or IVQ2 - 12h PO/IV/SQ20 mgRadha Krishna et al, 2012 [62]; Hui et al, 2017 [63]; Wang et al, 2012 [64]
Loxapine10 - 50 mg PO. The usual therapeutic range is 60 - 100 mg daily.Q12h250 mgRiddle et al, 2017 [65]; Schmiedl et al, 2019 [66]; Rahman et al, 2014 [67]
Clozapine12.5 - 25 mg POQ12h (varies)Up to 300 - 400 mg/dayDeodhar et al, 2014 [68]; Pakhre et al, 2016 [69]

 

Table 2. Chemotherapy-Induced Affective and Behavioral Disturbances
 
AgentMalignancyPresentationReferences
5-fluorouracilColorectal cancerAcute manic episodeHa et al, 2011 [81]
MethotrexateAcute lymphocytic leukemia (ALL)Acute manic episodeHariram et al, 2013 [82]
CisplatinTonsillar cancerMania and poor impulse controlBarlinn et al, 2015 [83]
Docetaxel and cisplatinNon-small cell lung cancerLate-onset bipolar disorderDeKay et al, 2011 [84]
CisplatinGastric cancerHypomaniaMatsunaga et al, 2012 [85]
Capecitabine and oxaliplatinColorectal cancerAcute manic episodeGarg et al, 2018 [17]
DexamethasoneNon-small cell lung cancerSteroid-induced maniaWarren et al, 2019 [86]
Lenalidomide, bortezomib, dexamethasoneMultiple myelomaMania and hyperactive deliriumPavlova et al, 2020 [87]
DasatinibChronic myeloid leukemiaDepression with agitationSami et al, 2014 [88]
Imatinib and dasatinibChronic myeloid leukemiaDepression with agitationQuek et al, 2009 [89]