Pharmacological Treatment of Psychotic Disorders

Abstract

Treatment of psychotic disorders in cancer patients represents a challenge for clinicians. Psychotic symptoms (e.g., delusions, perceptual disorders), unusual behavior or inappropriate affect, and low adherence may be a problem for healthcare teams in oncology and palliative care. Pharmacotherapy is the key of management of psychotic disorders, along with psychosocial therapies. Antipsychotic agents (APs) (first-generation or typical or conventional APs; atypical APs), benzodiazepines, or possibly certain anticonvulsants are used to manage psychotic disorders in cancer and palliative care settings. Attention to side effects of APs, including extra-pyramidal symptoms (e.g., acute dystonia, akathisia, parkinsonism-like symptoms, and tardive dyskinesia), possible anti-muscarinic symptoms (e.g., xerostomia, tachycardia, peristalsis impairment, urinary retention), neuroleptic malignant syndrome, and others, is necessary. Also possible cardiologic side effects (e.g., increase QTc length) should be monitored. Drug–drug interaction, given the possible overlapping of metabolic pathways (cytochrome P-450 enzyme systems) between APs and anticancer or palliative care medications, needs also to be carefully examined when prescribing drugs to psychotic patients with cancer.