Brain lesions manifesting as psychiatric disorders: eight cases

Drug-resistant schizophrenia-like psychosis associated with temporal non-anaplastic pleomorphic xanthoastrocytoma: unusual revealing symptom of a rare pathology

Introduction and importance

Pleomorphic xanthoastrocytoma (PXA) was first described by Kepes et al. in 1979. Fewer than 200 cases have been reported in the literature. It generally involves the temporoparietal lobe. PXA has a favorable prognosis. The most reported clinical manifestation is epileptic seizures. Revealing psychiatric symptoms have an incidence varying from 50 to 78%. The most common symptoms encountered are anxiety disorders, depression, schizophrenia-like psychosis, cognitive dysfunction or even anorexia nervosa.

Case presentation

Here, the authors report a new case of non-anaplastic pleomorphic xanthoastrocytoma revealed by a drug-resistant schizophrenia-like psychosis in a 26-year-old male patient known with epileptic seizures in whom these two pathologies were intertwined and had been evolving for 5 years. The postoperative course was uneventful, and positive symptoms of schizophrenia were relatively stabilized at discharge.

Clinical discussion

Given the superficial hemispheric location of PXA, the most common clinical presentation is seizures. Psychiatric symptoms revealing brain tumors have an incidence varying from 50 to 78%. Most of these symptoms concern frontal and limbal tumors. In their case, the tumor was located in the right temporal lobe. Surgery was performed and postoperative course was uneventful even though there are conflicting reports regarding the importance of the surgical excision quality.

Conclusion

PXA remains a rare and benign primary CNS tumor. Psychiatric disorders represent a rare revealing mode of this pathology, which must lead to neuroimaging in any patient carrying this type of symptoms.

Neuropsychiatric Manifestations of a Frontal Lobe Meningioma: A Case Report

The exclusion of organic causes for psychiatric symptoms is a routine practice in mental healthcare. Brain tumors can elicit a range of mood, behavioral, or cognitive symptoms that mimic mental health disorders, significantly altering a patient's personality and behavior if left undiagnosed or untreated. This case report presents a 56-year-old Middle Eastern male with no prior history of mental illness who exhibited a three-week history of depressive symptoms, social withdrawal, and poor self-care. Despite treatment, his condition deteriorated, manifesting psychomotor retardation, urinary incontinence, paranoia, mood lability, and sexually disinhibited behavior. Neuroimaging revealed a large extra-axial mass in the anterior cranial fossa, indicative of a meningioma, necessitating referral to neurosurgery. CT and MRI scans confirmed a hyperdense mass lesion (7.1 x 7.7 x 7.5 cm), causing structural erosion and a midline shift. This case underscores the importance of considering organic causes in atypical psychiatric presentations. Meningiomas, particularly those in the frontal lobes, can present primarily with psychiatric symptoms, complicating early diagnosis. Neuroimaging is critical for accurate diagnosis and effective management in such cases. Clinicians should be vigilant for organic causes in patients with atypical psychiatric symptoms, especially in those over 50. Early neuroimaging can lead to timely diagnosis and treatment, significantly improving patient outcomes.

Study of Association of Various Psychiatric Disorders in Brain Tumors

Background  Brain tumors may be associated with high morbidity, and psychiatric symptoms may be an early manifestation. It is important to address mental symptoms as early as possible because they are prone to develop psychiatric comorbidities in future. If untreated, these situations may worsen and lead to burden upon caregivers. Methods  A total of 176 brain tumor patients between January 2021 and January 2022 constituted the sample size. All recently diagnosed cases of brain tumor with age equal to or more than 18 years who can comprehend and answer questionnaires were included. Patients with a long history of brain tumor or who had a history of a psychiatric illness other than presenting symptoms or any other serious medical illness were excluded. Results  Twenty-seven percent of brain tumor patients had psychiatric symptoms. Depressive symptoms were the most common, associated with 24% of patients, followed by anxiety disorders. Psychiatric disorders were more common in supratentorial compared to infratentorial tumors. Psychiatric symptoms seem to be associated more commonly with malignant tumors and peritumoral edema. Among malignant tumors, depressive symptoms tend to be related with high-grade glioma, and among benign tumors, they were more common in meningioma. No predilection to laterality and anatomical lobe involvement is reported. Conclusion  Screening of psychiatric disorders should be a routine in brain tumor patients. An integrated approach is required to treat brain tumor patients. Healthcare professionals should be more vigilant about the onset of psychiatric symptoms and the need of palliative care to improve the quality of life.

Schizophrenia-Like Psychosis Presented in a Patient With a Temporal Lobe Tumor: A Case Report

Psychiatric symptoms caused by brain lesions are not uncommon nowadays, caused by several different pathologies such as Alzheimer's, dementia, vascular and oncological diseases, etc. and they are known as neuropsychiatric or neurobehavioral symptoms, overlapping as mental health disorders. The most common primary brain tumors are gliomas, and the most common neuropsychiatric symptoms caused by them are depression, anxiety disorder, schizophrenia-like psychosis, anorexia nervosa, or cognitive dysfunction. We present a case of a 46-year-old male with no psychiatric familial history who started with a schizophrenia-like psychosis with hallucinations and, in consequence, killed his mother, symptoms which, after almost eight years, were known to be caused by a brain tumor.

Fourteen-Year-Old Boy With Intracranial Internal Carotid Artery Aneurysm Presenting as Mood Disorder

Intracranial aneurysms (IA) are very uncommon to find in the pediatric population. If present, it is usually associated with other genetic illnesses. Most of the intracranial aneurysm has been presented due to mass effect of the aneurysm or as subarachnoid hemorrhage. We report this young Asian kid who has had a possible ictus of subarachnoid hemorrhage (SAH) with depressive symptoms, later presenting with classic features of SAH due to rupture of intracranial internal carotid artery aneurysm. The use of Sertraline to treat depressive episodes may aggregate the condition due to its antiplatelet effect. The patient showed significant improvement following microsurgical clipping of the aneurysm. This case is another example that young patients coming with the first episode of mood disorder should be carefully excluded for other intracranial pathology, including intracranial aneurysms, before coming to the final diagnosis.

Brain tumors and indications for brain imaging in patients with psychiatric manifestations: a case report

Background

Studies on the relationship between psychiatric symptoms and brain tumors are ambiguous, as it is not clear whether these symptoms are due to the direct effect of the tumor or a secondary psychological response to stress, resulting from the diagnosis and treatment of the disease; therefore, it is difficult to analyze and retrieve relevant information.

Case presentation

We present the case of a 43-year-old male patient, who was admitted to a psychiatric emergency room with psychiatric symptoms, such as restlessness and extreme talkativeness, but normal neurological examinations. He showed no response to outpatient treatment and had no history of psychiatric disorders. The onset of symptoms was 2 months before his visit. On neuroimaging, a brain tumor was observed in the right temporal and occipital lobes. Accordingly, the patient was transferred to the neurosurgery ward.

Conclusion

Factors, such as increased internal pressure on the brain due to a brain tumor or the effect of tumor area, contribute to the occurrence of symptoms, such as restlessness and talkativeness. However, further studies are needed to confirm these findings.

Atypical Charles Bonnet syndrome secondary to frontal meningioma: a case report

BACKGROUND

Charles Bonnet Syndrome (CBS) is a rare clinical entity that is classically composed of visual hallucinations in the context of an altered optic pathway with preservation of reality judgment. This case aims to present the association of visual hallucinations with complex alterations of the nervous structures adjacent to the visual pathway and an atypical clinical presentation, thus explaining the possible mechanisms involved in the generation of these symptoms.

CASE PRESENTATION

A 43-year-old man presents seeking care due to visual hallucinations with partial preservation of reality judgment and symptoms compatible with a major depressive disorder, including irritability and diminished hygiene habits. He has a history of complete gradual loss of vision and hyposmia. Due to poor treatment response during hospitalization, an MRI was obtained, which showed a frontal tumor lesion with meningioma characteristics adjacent to the olfactory groove and compression of the optic chiasm. He underwent surgical resection of the lesion, which remitted the psychotic symptoms, but preserving the visual limitation and depressive symptoms.

CONCLUSIONS

The presence of visual hallucinations, without other psychotic features as delusions, is a focus of attention for basic structural pathologies in the central nervous system. Affection at any level of the visual pathway can cause CBS. When finding atypical symptoms, a more in-depth evaluation should be made to allow optimization of the diagnosis and treatment.

Presenting Psychiatric and Neurological Symptoms and Signs of Brain Tumors before Diagnosis: A Systematic Review

Brain tumors can present with various psychiatric symptoms, with or without neurological symptoms, an aspect that complicates the clinical picture. However, no systematic description of symptoms that should prompt a neurological investigation has been provided. This review aims to summarize available case reports describing patients with brain tumors showing psychiatric symptoms before brain tumor diagnosis, in order to provide a comprehensive description of these symptoms as well as their potential relationship with delay in the diagnosis. A systematic literature review on case reports of brain tumors and psychiatric symptoms from 1970 to 2020 was conducted on PubMed, Ovid, Psych Info, and MEDLINE. Exclusion criteria comprised tumors not included in the World Health Organization (WHO) Classification 4th edition and cases in which psychiatric symptoms were absent or followed the diagnosis. A total of 165 case reports were analyzed. In a subset of patients with brain tumors, psychiatric symptoms can be the only manifestation or precede focal neurological signs by months or even years. The appearance of focal or generalized neurological symptoms after, rather than along with, psychiatric symptoms was associated with a significant delay in the diagnosis in adults. A timely assessment of psychiatric symptoms might help to improve early diagnosis of brain tumors.

Subtle neuropsychiatric symptoms of glioblastoma multiforme misdiagnosed as depression

Glioblastoma multiforme (GBM) is the most common of the aggressive primary brain tumours arising in adults and has a dire prognosis. Neuropsychiatric symptoms can vary significantly among afflicted persons; psychiatric disturbances may be the predominant presenting symptoms. Distinguishing between functional psychiatric disorders, particularly depression, from other subtle neuropsychiatric disturbances that may accompany GBM can be challenging. The authors present a clinical case and review of the literature in an attempt to highlight the special considerations that should be taken into account when evaluating patients who present with late-onset or atypical symptoms, refractory psychiatric symptoms, or subtle neurological disturbances signalling the need for diagnostic assessment, particularly neuroimaging, for the presence of a tumour. Early diagnosis is critical for improvement in quality of life.

A retrospective chart review of clinical characteristics and magnetic resonance imaging findings of patients from a psychiatric facility in KwaZulu-Natal province, South Africa

Background

Many neurological conditions manifest with psychiatric symptoms and may be misdiagnosed. Structural neuroimaging, that is, computerised tomography (CT) and magnetic resonance imaging (MRI), can aid in the diagnosis or exclusion of these conditions. Magnetic resonance imaging is preferable in this regard, but is more expensive and less readily available than CT. The indications for requesting MRI in the clinical psychiatric setting remain poorly defined. All published literature on the clinical utility of neuroimaging in Africa is on CT scans.

Aim

The aim of this study was to describe the clinical characteristics and MRI findings in a cohort of patients presenting with psychiatric symptoms.

Setting

A specialist psychiatric training hospital, Townhill Hospital, in Pietermaritzburg, KwaZulu-Natal.

Methods

A retrospective chart review of all patients who underwent MRI between 01 October 2010 and 31 June 2016 was done. Magnetic resonance imaging findings were correlated with socio-demographic and clinical information, including psychiatric diagnosis, indication for MRI imaging and effect on clinical management.

Results

Fifty-three MRIs were performed. Thirty-three (62%) were abnormal. Patients with HIV, neurocognitive disorders, chronic mental illness and involuntary admission were more likely to have abnormal scans (83%, p = 0.089; 80%, p = 0.496; 71%, p = 0.089 and 79%, p = 0.021, respectively). The findings of 54% of abnormal MRIs (24% of all MRIs performed) resulted in referral to other disciplines. No statistically significant associations were found with socio-demographic or clinical factors.

Conclusion

Abnormalities on MRI scans in mentally ill patients were common and a quarter of patients required referral to other disciplines. Further studies are required to clarify the clinical utility of MRI in patients with psychiatric illness, which could assist in the development of a guide for the rational use of this modality in a resource-constrained environment.

Diagnostic yield of head CT in pediatric emergency department patients with acute psychosis or hallucinations

BACKGROUND

Children presenting to the emergency department with acute psychosis or hallucinations sometimes undergo a head CT to evaluate for a causative lesion. The diagnostic yield of head CT in this scenario has not been reported.

OBJECTIVE

To determine the yield for head CT in children with acute psychosis or hallucinations.

MATERIALS AND METHODS

We retrospectively searched the radiology report database over a 7.5-year period for head CT reports for pediatric emergency department patients using the following keywords: hallucination, psychosis, psychotic or "hearing voices." All reports were categorized as normal or abnormal, and we reviewed and categorized the abnormal cases. We calculated the 95% confidence interval for abnormal CTs using the method of Clopper and Pearson.

RESULTS

We identified 397 pediatric emergency department head CTs. We excluded one non-diagnostic exam. We excluded 34 additional cases (which were all normal) because of clinical indications that might have independently triggered a head CT. Of the remaining 362 cases, 12 reports described abnormalities or variants and we reviewed them individually. Based on consensus review, four were normal, four had congenital malformations, three had encephalomalacia versus demyelination and one demonstrated cortical atrophy. There were no cases with actionable findings such as mass, hemorrhage, infection or hydrocephalus. The 95% confidence interval for a CT demonstrating causative findings was calculated at 0-0.82%.

CONCLUSION

In the absence of concerning factors such as focal neurological deficits, evidence of central nervous system infection, trauma or headache, routine screening head CT might not be warranted in children presenting with acute psychosis or hallucinations.

The psychopharmacology of primary and metastatic brain tumors and paraneoplastic syndromes

Brain tumors and paraneoplastic syndromes can cause various neuropsychiatric symptoms. Rarely, psychiatric symptoms may be the initial presentation of the underlying neurologic lesion. Brain imaging studies are crucial in the diagnosis of brain tumors. Paraneoplastic syndromes are mostly immune-mediated, and antineuronal antibodies may be detected in the blood or cerebrospinal fluid. Clinical suspicion is very important in assisting the diagnostic workup. Treatment of the psychiatric symptoms depends on the nature of the symptoms. Selection of the psychotropic agent has to be done carefully to minimize complications such as seizures and delirium secondary to anticholinergic toxicity. With advances in targeted therapies, immunology, and genetics, the future appears more promising.

Paranoid Syndrome as the First Sign of Central Neurocytoma: A Case Report

Central neurocytoma (CN), first described in 1982 by Hassoun and colleagues, is a rare tumor accounting for 0.25% to 0.5% of all tumors of the central nervous system. The tumor is a neoplasm of neuroepithelial origin, with intermediate malignancy (WHO grade II), detectable with both computed tomography and magnetic resonance imaging. Complete excision of the tumor gives favorable long-term results, with infrequent recurrences and/or metastases. Only 3 previous cases in which CN presented with co-occurring psychotic symptoms were found in the PubMed database. This report presents the case of a 27-year-old patient with paranoid syndrome without neurological symptoms, in whom magnetic resonance imaging confirmed a large intracranial tumor located predominantly in the right lateral ventricle and third ventricle reaching down to the hypothalamus. Resection of the tumor (histopathologically a CN) resulted in complete remission of the psychotic symptoms. This case supports the need for neuroimaging in all patients with first-episode psychosis because of the possibility of neurologically silent brain tumors. Quick diagnosis in such cases is crucial for the selection of treatment methods and prognosis.

Depression and glioblastoma, complicated concomitant diseases: a systemic review of published literature

Glioblastoma multiforme (GBM) is the most common primary brain cancer. Depression is a common co-morbidity of this condition. Despite this common interaction, relatively little research has been performed on the development of GBM-associated depression. We performed a literary search of the PubMed database for articles published relating to GBM and depression. A total of 85 articles were identified with 46 meeting inclusion criteria. Depression significantly impacts care, decreasing medication compliance, and patient survival. Diagnostically, because depression and GBM share intricate neuro-connectivity in a way that effect functionality, these diseases can be mistaken for alternative psychological or pathological disorders, complicating care. Therapeutically, anti-depressants have anti-tumor properties; yet, some have been shown to interfere with GBM treatment. One reason for this is that the pathophysiological development of depression and GBM share several pathways including altered regulation of the 5-HT receptor, norepinephrine, and 3':5'-cyclic monophosphate. Over time, depression can persist after GBM treatment, affecting patient quality of life. Together, depression and GBM are complicated concomitant diseases. Clinicians must be aware of their co-existence. Because of overlapping molecular pathways involved in both diseases, careful medication selection is imperative to avoid potential adverse interactions. Since GBMs are the most common primary brain cancer, physicians dealing with this disease should be prepared for the development of depression as a potential sequela of this condition, given the related pathophysiology and the known poor outcomes.

Why in the age of CT scans and MRIs is a brain tumour mistaken for a psychiatric illness?

The first author of this paper operated on two patients with brain tumour, who had been undergoing long-term treatment for depression. In the age of CT scans and MRIs, why are there still cases in which a brain neoplasia is mistaken for a psychiatric condition with consequent serious delays in diagnosis? In this article, we have highlighted what in our experience are three noticeable obstacles in achieving the right diagnosis.

Olfactory Fossa Meningioma Presenting as Depressive Disorder: A Case Report

Meningiomas are common, usually benign intracranial tumors. They grow slowly and can remain asymptomatic for many years. Meningiomas can present as mental disorders rather than with neurologic signs or symptoms. In this case report we describe a middle-aged man with a 2-year history of depressive disorder who was diagnosed with a large olfactory fossa meningioma after he developed mental status changes and urinary incontinence. After the tumor was removed, the patient's depressive symptoms resolved and his neurocognitive functions improved. We discuss the patient's neuropsychological and psychiatric profiles to identify symptoms and other clues that could expedite identification of meningiomas in patients with psychiatric disorders. Because olfactory fossa meningiomas can present as depressive disorder, we recommend brain imaging to rule out organic brain lesions in middle-aged and older patients with new-onset psychiatric symptoms. Although tumor removal brought improvement of our patient's mental state and neurocognitive functions, patients may not be able to recover their cognitive functions completely.

Proteomic Biomarker Identification in Cerebrospinal Fluid for Leptomeningeal Metastases with Neurological Complications

Leptomeningeal metastases (LM) from solid tumours, lymphoma and leukaemia are characterized by multifocal neurological deficits with a high mortality rate. Early diagnosis and initiation of treatment are essential to kerb neurological deterioration. However, this is not always possible as 25% of cerebrospinal fluid samples produce false-negative results at first cytological examination. The identification of biomarkers that allow stratification of individuals according to risk for developing LM would be a major benefit. Proteomic-based approaches are now in increasing use for this purpose, and these are reviewed in this chapter with a focus on cerebrospinal fluid (CSF) analyses. The construction of a CSF proteome disease database would also facilitate analysis of other neurological disorders.

Unruptured anterior communicating artery aneurysm presenting as depression: A case report and review of literature

Background:

Intracranial aneurysms most commonly present following rupture causing subarachnoid hemorrhage. Mental disorders are common among patients with unruptured intracranial aneurysms and in aneurysmal subarachnoid hemorrhage survivors. However, to the best of our knowledge, there is no published report of unruptured intracranial aneurysm presenting as a mental disorder.

Case Description:

A 69-year-old male without a past history of mental disorders and neurological symptoms presented with a 2-month history of anxiety, sadness, lack of pleasure in usual activities, fatigue, difficulties falling asleep and waking up early in the morning, reduced appetite, and weight loss. The patient was diagnosed with major depressive disorder and antidepressant treatment was initiated. Subsequent non-contrast computed tomography (CT) of the head demonstrated hypointense oval-shaped lesion within the projection of the anterior communicating artery. CT angiography confirmed the diagnosis of a 0.8 × 0.6 cm saccular aneurysm originating from the anterior communicating artery and anterior cerebral artery. The patient underwent microsurgical clipping of the aneurysm. On psychiatric assessment 1 month after the surgery, there were no signs of depressive disorder and antidepressive treatment was discontinued. On follow-up visit 1 year after the surgery, the patient did not have any mood symptoms.

Conclusions:

The case indicates that organic brain lesions, including intracranial aneurysms, should be suspected in elderly patients presenting with their first episode of mental disorder.

Tumor infiltrating immune cells in gliomas and meningiomas

Tumor-infiltrating immune cells are part of a complex microenvironment that promotes and/or regulates tumor development and growth. Depending on the type of cells and their functional interactions, immune cells may play a key role in suppressing the tumor or in providing support for tumor growth, with relevant effects on patient behavior. In recent years, important advances have been achieved in the characterization of immune cell infiltrates in central nervous system (CNS) tumors, but their role in tumorigenesis and patient behavior still remain poorly understood. Overall, these studies have shown significant but variable levels of infiltration of CNS tumors by macrophage/microglial cells (TAM) and to a less extent also lymphocytes (particularly T-cells and NK cells, and less frequently also B-cells). Of note, TAM infiltrate gliomas at moderate numbers where they frequently show an immune suppressive phenotype and functional behavior; in contrast, infiltration by TAM may be very pronounced in meningiomas, particularly in cases that carry isolated monosomy 22, where the immune infiltrates also contain greater numbers of cytotoxic T and NK-cells associated with an enhanced anti-tumoral immune response. In line with this, the presence of regulatory T cells, is usually limited to a small fraction of all meningiomas, while frequently found in gliomas. Despite these differences between gliomas and meningiomas, both tumors show heterogeneous levels of infiltration by immune cells with variable functionality. In this review we summarize current knowledge about tumor-infiltrating immune cells in the two most common types of CNS tumors-gliomas and meningiomas-, as well as the role that such immune cells may play in the tumor microenvironment in controlling and/or promoting tumor development, growth and control.

Meningiomatosis revealed by a major depressive syndrome

Depressive symptoms may be the only expression of brain tumours. Thus, it is challenging to suspect a brain tumour when patients with depression have a normal neurological examination. We illustrate this by a case report regarding a meningiomatosis revealed by a treatment-resistant depressive syndrome that improved after surgery. This case highlights the importance of identifying signs of brain tumour in patients with depression. Although there is no consensus about whether brain imaging is indicated for depressive syndromes, it should be performed, particularly in late onset of depressive syndrome (after 50 years of age), treatment-resistant depression or in apathy with a reduced emotional response or without dysphoric manifestations.

[Mnesic disorders caused by left temporal gliomas]

Episodic memory disorders are frequent in patients with temporal lesion. Verbal or visuo-spatial memory disorders depend on the location and the lateralization of the lesion. These disorders are well described in temporal epilepsy but rarely in population with cerebral tumor and especially not specifically focus on temporal glioma. The purpose of this study was to describe neuropsychological examination in patient with temporal glioma in the database of the regional memory centre of Besançon. Four patients were identified (all right-handed and with a left temporal glioma). Verbal episodic memory impairment and auditory-verbal short-term memory impairment were observed. One patient had also visual memory disorders. Therefore, further investigations showed an associated Alzheimer's disease. This finding modified the clinical management of this patient. Extensive neuropsychological assessment should be systematic initially to seek an associated pathology, especially in elderly patients, if the cognitive profile is unusual, during the follow-up to better understand cognitive evolution and the effect of therapies on cognition.

Depression screening in patients with brain tumors: a review

Brain tumor (BT) is often a devastating disease associated with poor prognosis. Depression is a common complication in BT patients that often remains under-recognized and untreated. Implementation of reliable depression screening algorithms in routine neuro-oncology setting could potentially improve recognition of depression. The Hospital Anxiety and Depression scale-Depression subscale and Patient Health Questionnaire-9 demonstrated adequate psychometric properties for depressive disorder screening in glioma patients. Patients screened positive for depression should be referred for detailed psychiatric assessment prior to initiating anti-depressive treatment. Further methodologically rigorous studies investigating psychometric properties of single-item and multiple-item depression scales are urgently warranted. Studies evaluating anti-depressive treatments' efficacy and clinical value of depression biomarkers are important avenues for future research endeavors in BT patients.

Depression as first manifestation of a large intracerebral lymphoma

OBJECTIVE

The differentiation between a 'non-organic' depressive episode and an organic depressive disorder on the basis of clinical grounds might be challenging.

METHODS

We report a case with an initially typical severe depressive episode without any focal neurological deficits.

RESULTS

Only medical history from a third party raised doubts about this provisional diagnosis. Brain magnetic resonance imaging revealed a highly malignant diffuse large intracerebral B-cell lymphoma in the right frontal lobe changing the diagnosis into an organic depressive disorder. The patient recovered after neurosurgical resection, chemotherapy and autologous stem cell transplantation.

CONCLUSION

This report helps to reduce possible errors in the differential diagnosis of depressive disorders by underlining the importance of a comprehensive medical history including anamnesis from a third party and neuroimaging, especially in first or atypical manifestation of depressive disorders.

Is the screening for celiac disease useful in anorexia nervosa?

The main objective of the study was to prospectively assess if the prevalence of celiac disease (CD) in patients with anorexia nervosa (AN) is higher than that reported in the general population to require a regular screening program. The study was conducted at the Neuropsychiatry Unit of "Bambino Gesù" Children's Hospital in Rome from January 2005 to December 2010. All patients with diagnosis of AN according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria were screened for CD. One hundred and seventy-seven patients (33 males and 144 females) were enrolled. Only one patient was found to be affected with CD as confirmed by intestinal biopsy. The overall prevalence of CD in AN patients was 0.6 % which is similar to that observed in the general population. In conclusion, AN patients do not seem to require a regular screening program for CD. The screening for CD may be useful in selected AN patients in which the symptoms are only partially responding to psychiatric interventions.

Modifications of default-mode network connectivity in patients with cerebral glioma

Purpose

The aim of the study was to evaluate connectivity modifications in the Default Mode Network (DMN) in patients with cerebral glioma, and to correlate these modifications to tumor characteristics.

Methods

Twenty-four patients with a left-hemisphere cerebral tumor (14 grade II and 10 grade IV gliomas) and 14 healthy age-matched right-hand volunteers were enrolled in the study. Subjects underwent fMRI while performing language tasks for presurgical mapping. Data was analyzed with independent component analysis in order to identify the DMN. DMN group maps were produced by random-effect analysis (p<0.001, FDR-corrected). An analysis of variance across the three groups (p<0.05) and post-hoc t-test contrasts between pairs of groups were calculated (p<0.05, FDR-corrected).

Results

All three groups showed typical DMN areas. However, reduced DMN connectivity was detected in tumor patients with respect to controls. A significantly increased and reduced integration of DMN areas was observed in the hippocampal and prefrontal regions, respectively. Modifications were closely related to tumor grading. Moreover, the DMN lateralized to the hemisphere contralateral to tumor in the low-grade, but not in the high-grade tumor patients.

Conclusion

Modifications of DMN connectivity were induced by gliomas and differed for high and low grade tumors.

Brain tumor location and psychiatric symptoms: is there any association? A meta-analysis of published case studies

A meta-analytic study of reports of brain tumors and psychiatric symptoms for the past 50 years was conducted to examine potential associations between tumor location and psychiatric symptoms. Results demonstrated that there is a statistically significant association between anorexia symptoms and hypothalamic tumors. For the rest of the brain regions a statistically significant association could not be definitively determined. However, several of the regions demonstrated an increased likelihood of associated symptoms when compared with other regions. The methodological limitations of this analysis are discussed.

Neuroimaging in psychiatric disorders

In psychiatry, neuroimaging facilitates the diagnosis of psychiatric disorders and the development of new medications. It is used to detect structural lesions causing psychosis and to differentiate depression from neurodegenerative disorders or brain tumors. Functional neuroimaging, mostly in the form of molecular neuroimaging with positron emission tomography or single photon emission tomography, facilitates the identification of therapeutic targets, the determination of the dose of a new drug needed to occupy its target in the brain, and the selection of patients for clinical trials.