In a recent case, I was asked to see a man, age 69, on the oncology service who was receiving corticosteroids every 2 weeks as part of his chemotherapy. The patient was admitted to the hospital for acute mental status changes 2 days after his last corticosteroid dose. He had pressured speech, grandiosity, and had not slept in 2 days. We started risperidone, 1 mg bid, and most of his manic symptoms resolved within 2 days. His chemotherapy was continued without corticosteroids. If this had not been not possible, I would have recommended continuing risperidone prophylactically.
Electroconvulsive therapy can be effective for mania and psychotic depression. 27 Behavioral interventions (., cognitive behavior therapy, caregiver support, psychoeducation regarding the early warning signs of mood relapse) are considered first-line adjuncts to pharmacotherapy to improve social function and reduce the need for medications, number of hospitalizations, and relapse rates. 7 , 31 – 33 Early warning signs of a mood relapse include sleep disturbance, agitation, increased goal orientation, and a disruption in usual routine. The risk of suicide is lowered with increased satisfaction with care, lithium therapy, and treatment of alcohol and tobacco abuse. 7 , 9 , 34