title: Hypomanic episode during recurrent gastric cancer treatment: report of a rare case and literature review.
abstract: S-1 plus cisplatin is the standard chemotherapy for recurrent gastric cancer. While depression and delirium are frequent in cancer patients, hypomania during chemotherapy is rare. We describe a rare case of hypomania during S-1 plus cisplatin treatment for recurrent gastric cancer. A 66-year-old woman, with no previous psychiatric disorder, received S-1 plus cisplatin for recurrent gastric cancer. She showed peculiar behavior. Physical examination, urine, blood and imaging findings were normal. There was no gastric cancer progression. During psychiatric consultation, she behaved inappropriately. However, she behaved normally while performing daily activities. She manifested a persistently elevated, expansive or irritable mood, clearly different from her usual non-depressed state, meeting hypomania diagnostic criteria. Her condition did not require chemotherapy discontinuation or additional medication. During the second and subsequent S-1 plus cisplatin cycles, symptoms were stable. Cancer patients often have adjustment disorders, depression and delirium, but rarely hypomania. Our patient showed no significant changes in blood biochemistry and brain and whole body imaging. While S-1 plus cisplatin-induced hypomania cannot be excluded, hypomanic symptoms did not improve during the chemotherapy rest period, nor was there deterioration during subsequent cycles, suggesting drug-induced mania to be unlikely. Possible onset mechanisms include manic defense phenomena, common with stressful life events. There are no reports of recurrent gastric cancer patients experiencing hypomania during S-1 or S-1 plus cisplatin therapy, i.e. our patient represents a rare course. Clinicians should recognize psychosis or mood disorders during gastric cancer treatment. Further accumulation of such rare cases might elucidate pathological mechanisms underlying hypomania in cancer patients.
authors.affiliation: Department of Medical Oncology, International Medical Center-Comprehensive Cancer Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, Japan. mmandmacgyver@yahoo.co.jp
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Matsunaga
authors.forename: Hideki
authors.initials: H
authors.lastname: Onishi
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ishida
authors.forename: Keisuke
authors.initials: K
authors.lastname: Miwa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Araki
authors.forename: Toshikado
authors.initials: T
authors.lastname: Kaneta
authors.forename: Yu
authors.initials: Y
authors.lastname: Sunakawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Ken
authors.initials: K
authors.lastname: Shimada
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Noguchi
authors.forename: Masaru
authors.initials: M
authors.lastname: Narabayashi
authors.forename: Yasutsuna
authors.initials: Y
authors.lastname: Sasaki
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000139:chemically induced* / Q000175:diagnosis*; D002945:Cisplatin / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D010094:Oxonic Acid / Q000008:administration & dosage; D011379:Prognosis; D012196:Review Literature as Topic; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000556:secondary; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D002945:Cisplatin