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A case of diverse psychiatric and functional impairments following immune checkpoint inhibitor therapy

Takako Ikegami1,2, Ryoichi Sadahiro3, Junji Yamaguchi3

  • 1Department of Palliative Medicine National Cancer Center Hospital Chuoku Tokyo Japan.

PCN Reports : Psychiatry and Clinical Neurosciences
|February 9, 2026
PubMed

Insights

Immune checkpoint inhibitors (ICIs) can cause rare neuropsychiatric immune-related adverse events (irAEs). Prompt multidisciplinary evaluation is crucial for diagnosing and managing these challenging neurological complications in cancer patients.

Area of Science:

  • Oncology
  • Neuroscience
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs).
  • Neuropsychiatric irAEs are rare but can present with non-specific symptoms, complicating diagnosis.
  • Early recognition of irAEs is critical for patient management.

Purpose of the Study:

  • To highlight the diagnostic challenges of neuropsychiatric irAEs.
  • To emphasize the importance of a multidisciplinary approach in managing these events.
  • To present a case of immune-related encephalopathy secondary to ICI therapy.

Main Methods:

  • Case report of a patient with gastric cancer treated with nivolumab.
  • Clinical presentation, diagnostic workup (MRI, CSF), and treatment interventions were documented.
  • Multidisciplinary assessment involving psychiatry and neurology.

Main Results:

  • The patient developed impaired consciousness, delusions, and behavioral changes during ICI therapy.
  • Initial diagnosis was suspected dementia, delaying recognition of irAE.
  • Treatment with steroids and antipsychotics led to symptom improvement, with a relapse managed by adjusting medication.

Conclusions:

  • New-onset psychiatric symptoms in patients on ICI therapy warrant suspicion for irAEs.
  • A multidisciplinary approach is essential for accurate diagnosis and effective management of neuropsychiatric irAEs.
  • Timely intervention can improve outcomes for patients experiencing ICI-induced neurological complications.
Abstract

Keywords:
central nervous system immune‐related adverse eventsgastric cancerimmune checkpoint inhibitorimmune‐mediated encephalitispsycho‐oncology

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