title: Temporary loss of moral behavior in a patient undergoing chemotherapy with cisplatin - breaking bad.
abstract: BACKGROUND
  Behavioral disturbances following chemotherapy with cisplatin are rare. Here, we report a patient with temporary loss of moral behavior in the setting of cisplatin-based chemotherapy for treatment of tonsillar cancer.
  
  
  METHODS
  A 66-year-old Caucasian male with no psychiatric or violent history was started on chemotherapy with cisplatin for treatment of tonsillar cancer. During the following weeks, the patient developed profound personality changes involving volatile emotions and impulsive aggression with verbal and physical assaults on others. Admitted to the hospital, the patient lacked any awareness that his behavior was wrong. Chemotherapy was discontinued and the patient was prescribed risperidone. Aside from mild cognitive impairment, comprehensive neuropsychological, neuroradiological and lab testing were unremarkable. Three weeks following cessation of chemotherapy, the patient had recovered to his original mental state and he was completely aware of his wrongdoing and social misconduct.
  
  
  CONCLUSIONS
  Since neurotoxic effects of chemotherapeutics on the brain are not yet sufficiently elucidated, our case emphasizes that early signs of behavioral abnormalities in patients receiving chemotherapy should trigger comprehensive psychiatric evaluation and ongoing monitoring of the patients' mental state.
authors: Department of Psychiatry and Psychotherapy, Dresden-Friedrichstadt Municipal Hospital, Dresden, Germany. kristian.barlinn@uniklinikum-dresden.de.|Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany. kristian.barlinn@uniklinikum-dresden.de.
authors: Kristian
authors: K
authors: Barlinn
authors: Department of Psychiatry and Psychotherapy, Dresden-Friedrichstadt Municipal Hospital, Dresden, Germany. lehrach-ha@khdf.de.
authors: Hans
authors: H
authors: Lehrach
authors: Department of Psychiatry and Psychotherapy, Dresden-Friedrichstadt Municipal Hospital, Dresden, Germany. timo.siepmann@uniklinikum-dresden.de.|Institute of Clinical Pharmacology, Carl Gustav Carus Medical Faculty, University of Technology Dresden, Dresden, Germany. timo.siepmann@uniklinikum-dresden.de.
authors: Timo
authors: T
authors: Siepmann
authors: Department of Psychiatry and Psychotherapy, Dresden-Friedrichstadt Municipal Hospital, Dresden, Germany. braeuer-da@khdf.de.
authors: David
authors: D
authors: Braeuer
authors: Department of Psychiatry and Psychotherapy, Dresden-Friedrichstadt Municipal Hospital, Dresden, Germany. buntrock-ul@khdf.de.
authors: Ulrich
authors: U
authors: Buntrock
authors: Department of Psychiatry and Psychotherapy, Dresden-Friedrichstadt Municipal Hospital, Dresden, Germany. sassim-no@khdf.de.
authors: Norbert
authors: N
authors: Sassim
mesh_terms: D000342:Affective Symptoms / Q000139:chemically induced*; D000368:Aged; D000374:Aggression / Q000187:drug effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001364:Awareness / Q000187:drug effects; D002945:Cisplatin / Q000009:adverse effects*; D006801:Humans; D007175:Impulsive Behavior / Q000187:drug effects*; D008297:Male; D009014:Morals
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
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