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EV0873

Mania-like symptoms associated with frontal and subcortical metastatic involvement in small cell lung cancer

MANIA-LIKE SYMPTOMS ASSOCIATED WITH FRONTAL AND SUBCORTICAL METASTATIC INVOLVEMENT IN SMALL CELL LUNG CANCER

Right frontal cortical and left frontal subcortical brain metastases provided a possible neuroanatomical basis for a late-onset mania-like presentation, which was assessed as secondary mania.

The aim was to describe a mania-like presentation associated with frontal and subcortical brain metastases in a patient with small cell lung cancer. The clinical course, imaging findings, and treatment response of a 62-year-old man receiving chemoradiotherapy who was referred because of progressive behavioral changes over several months were evaluated. His symptoms included excessive spending, increased sexual interest, flirtatious behavior, a decreased need for sleep (less than 3 hours per night), increased talkativeness, inflated self-esteem, and increased goal-directed activity. The patient had no prior psychiatric or substance use history. Brain imaging performed one month before psychiatric admission had revealed frontal metastases, and valproate 1000 mg/day, initiated on an outpatient basis, had not produced meaningful improvement because of poor adherence. Brain magnetic resonance imaging demonstrated multiple metastatic lesions involving cortical and subcortical regions, particularly the right frontal cortex and left frontal subcortical white matter. These findings suggested disruption of the fronto-subcortical circuits involved in behavioral inhibition, impulse control, and mood regulation. Treatment was initiated with valproate 1500 mg/day, risperidone 4 mg/day, and quetiapine 300 mg/day; during follow-up, the doses were reduced to risperidone 3 mg/day and quetiapine 200 mg/day because of sedation. Progressive clinical improvement was observed during hospitalization. At discharge, mood was euthymic, psychomotor activity and the rate and amount of speech were within normal limits, no active psychotic symptoms were present, sleep and appetite had returned to baseline, and the mania-like symptoms had largely subsided. The late onset, absence of previous mood episodes, temporal association with brain metastases, and treatment response supported secondary mania rather than primary bipolar disorder. Clinically, new-onset manic symptoms in patients with cancer warrant investigation for structural brain pathology.

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