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Bokhari SA, Elnoor M, Al Mansour A, Mustafa K, Osman A. Neuropsychiatric Manifestations of a Frontal Lobe Meningioma: A Case Report. Cureus 2024; 16:e68101. [PMID: 39347214 PMCID: PMC11438519 DOI: 10.7759/cureus.68101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
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.
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Affiliation(s)
- Syed Ali Bokhari
- Psychiatry, Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, ARE
| | - Muhanad Elnoor
- Psychiatry, Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, ARE
| | - Alma Al Mansour
- Emergency Medicine, Al Qassimi Hospital, Emirates Health Services, Sharjah, ARE
| | - Khalid Mustafa
- General Practice, Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, ARE
| | - Abdelaziz Osman
- Psychiatry, Al Amal Psychiatric Hospital, Emirates Health Services, Dubai, ARE
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Avino A, Ion DE, Gheoca-Mutu DE, Abu-Baker A, Țigăran AE, Peligrad T, Hariga CS, Balcangiu-Stroescu AE, Jecan CR, Tudor A, Răducu L. Diagnostic and Therapeutic Particularities of Symptomatic Melanoma Brain Metastases from Case Report to Literature Review. Diagnostics (Basel) 2024; 14:688. [PMID: 38611601 PMCID: PMC11011469 DOI: 10.3390/diagnostics14070688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
The recent introduction of immunotherapy and targeted therapy has substantially enriched the therapeutic landscape of metastatic melanoma. However, cerebral metastases remain unrelenting entities with atypical metabolic and genetic profiles compared to extracranial metastases, requiring combined approaches with local ablative treatment to alleviate symptoms, prevent recurrence and restore patients' biological and psychological resources for fighting malignancy. This paper aims to provide the latest scientific evidence about the rationale and timing of treatment, emphasizing the complementary roles of surgery, radiotherapy, and systemic therapy in eradicating brain metastases, with a special focus on the distinct response of intracranial and extracranial disease, which are regarded as separate molecular entities. To illustrate the complexity of designing individualized therapeutic schemes, we report a case of delayed BRAF-mutant diagnosis, an aggressive forearm melanoma, in a presumed psychiatric patient whose symptoms were caused by cerebral melanoma metastases. The decision to administer molecularly targeted therapy was dictated by the urgency of diminishing the tumor burden for symptom control, due to potentially life-threatening complications caused by the flourishing of extracranial disease in locations rarely reported in living patients, further proving the necessity of multidisciplinary management.
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Affiliation(s)
- Adelaida Avino
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
- Discipline of Anatomy, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Abdalah Abu-Baker
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Cristian-Sorin Hariga
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristian-Radu Jecan
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Adrian Tudor
- Discipline of Anatomy and Embriology, University of Medicine, Sciences and Technology “George Emil Palade”, 540139 Targu Mures, Romania;
- Department of General Surgery I, Targu Mures Emergency Clinical Hospital, 540136 Targu Mures, Romania
| | - Laura Răducu
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
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Hanine I, Benallel K, Benjelloun R, Kadiri M. Seizures, Psychosis, and Cerebral Vascular Malformation: A Rare Chain of Events. Case Rep Psychiatry 2024; 2024:8656715. [PMID: 38288394 PMCID: PMC10824577 DOI: 10.1155/2024/8656715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
Background In psychiatry, anatomical abnormalities are sometimes forgotten, and this can mislead doctors into thinking that the diagnosis is purely psychiatric. A physical examination is important whenever it is possible. Even though cerebral arteriovenous malformations (cAVMs) are rare and can go unnoticed, in some cases they can cause clinical symptoms, which is a complication. Case Presentation. In this case, we describe a patient with no prior medical or psychiatric history having a cAVM diagnosed after showing psychotic symptoms (delusion and disorganized thoughts and behavior). The deep 4 × 5 cm cAVM was discovered after admitting the patient to psychiatric ward, the neurological cause has been considered after a recorded seizure, which brings the following question: Is the clinical presentation a direct result of the cAVM or is it postictal? Conclusions An abnormality leading to another, here is how we could describe our patient's psychopathology leading to psychotic symptoms. The two hypotheses explaining this case report have a low rate of occurring making this a rare case. Either way, neurological cause cannot be overlooked even if the clinical presentation is typical.
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Affiliation(s)
- Ismail Hanine
- Mohamed V Military Hospital of Rabat, Mohamed V University of Rabat, Rabat, Morocco
| | - Khadija Benallel
- Mohamed V Military Hospital of Rabat, Mohamed V University of Rabat, Rabat, Morocco
| | - Roukaya Benjelloun
- Mohammed VI University of Health Sciences of Casablanca, Casablanca, Morocco
| | - Mohamed Kadiri
- Mohamed V Military Hospital of Rabat, Mohamed V University of Rabat, Rabat, Morocco
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Regli LKP, Huijs SMH, Pasmans RCOS, Leue C, Dijkstra JB, Eekers DBP, Hovinga KE, Anten MHME, Hoeben A, Broen MPG. Incidence of clinically relevant psychiatric symptoms during glioblastoma treatment: an exploratory study. J Neurooncol 2023; 163:185-194. [PMID: 37162667 PMCID: PMC10232638 DOI: 10.1007/s11060-023-04326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE In addition to neurological symptoms glioblastoma (GBM) patients can experience psychiatric complaints, which are often hard to recognize and difficult to treat. Research on psychiatric symptoms during glioblastoma treatment is limited, but can have significant impact on quality of life, treatment processes and even survival. The aim of this study is to explore the incidence of clinically relevant psychiatric symptoms, during glioblastoma treatment and active surveillance. METHODS Medical records of 302 GBM patients were reviewed from diagnostic surgery until discontinuation of treatment or active surveillance. Clinical relevance was defined as psychiatric symptoms that interfered with the oncological treatment and required referral to a psychiatrist. "Referred" versus "non-referred" GBM patients were compared using the Pearson Chi-Square test, Fisher's Exact Test or Mann Whitney-U test. RESULTS Psychiatric symptoms occurred in 11.5% of patients during glioblastoma treatment or active surveillance, most often mood or behavioral symptoms, followed by psychotic symptoms. Referral occurred mainly during concomitant chemoradiation or adjuvant chemotherapy (64.3%). In 28.6% of patients psychiatric symptoms were thought to be attributive to medication. Treatment was discontinued in 17.9% of patients and temporarily interrupted in 3.6%. Possible risk factors included male gender, history of psychiatric disorder, postoperative delirium, non-frontal tumor location, anti-epileptic drug use at baseline and corticosteroid initiation during treatment. CONCLUSION The found incidence of 11.5% and the high number of patients discontinuing treatment due to psychiatric symptoms justify more research in this, to date, understudied topic in scientific literature. Further prospective studies are needed to identify risk factors and unravel possible effects on survival.
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Affiliation(s)
- L K P Regli
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S M H Huijs
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - R C O S Pasmans
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - C Leue
- Department Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNS, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - J B Dijkstra
- Department of Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - K E Hovinga
- Department of Neurosurgery, Maastricht UMC+, Maastricht, The Netherlands
| | - M H M E Anten
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - A Hoeben
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Medical Oncology, Maastricht UMC+, Maastricht, The Netherlands
| | - M P G Broen
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
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Puthenpura V, Nadkarni S, DiLuna M, Hieftje K, Marks A. Personality Changes and Staring Spells in a 12-Year-Old Child: A Case Report Incorporating ChatGPT, a Natural Language Processing Tool Driven by Artificial Intelligence (AI). Cureus 2023; 15:e36408. [PMID: 37090271 PMCID: PMC10115215 DOI: 10.7759/cureus.36408] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 03/22/2023] Open
Abstract
Low grade gliomas (LGGs) are the most common type of brain tumors diagnosed in children. The presentation of intracranial tumors in pediatric patients is varied and diverse. The early identification and treatment of LGGs are important to achieve favorable outcomes. Although personality changes can be a symptom of intracranial tumors, they are rarely the only main presenting feature. In addition to central nervous system (CNS) tumors, personality changes can be associated with psychological and endocrine conditions, contributing to a broad differential diagnosis. Because symptoms such as personality changes have the potential to be missed, communication between family members and clinicians is imperative to identify these symptoms early. We report the case of a 12-year-old child who presented with personality changes as her main symptom and was found to have an intracranial neoplasm. This case report integrates original author writing with output from ChatGPT, a natural language processing tool driven by artificial intelligence (AI). In addition to the case itself, this report will explore the benefits and drawbacks of using natural language AI in this context.
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Lesion network mapping of ectopic craniopharyngioma identifies potential cause of psychosis: a case report. Acta Neurochir (Wien) 2022; 164:3285-3289. [PMID: 36109364 DOI: 10.1007/s00701-022-05355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/21/2022] [Indexed: 02/01/2023]
Abstract
We report the case of a patient with craniopharyngioma who demonstrated ectopic spread to the right temporal lobe and concurrent local recurrence, 10 years after her initial diagnosis. The patient additionally demonstrated new-onset psychotic symptoms of uncertain etiology during her admission. Lesion network mapping identified the ectopic lesion as a putative cause for her psychosis. These findings were substantiated after the resection of the ectopic lesion and subsequent resolution of her psychiatric symptoms. This report adds to the rare accounts of ectopic craniopharyngioma, while highlighting the utility of network-based analyses in peri-operative tumor evaluation and the assessment of atypical neuropsychiatric phenomena.
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7
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Andrews JP, Wozny TA, Yue JK, Wang DD. Improved psychotic symptoms following resection of amygdalar low-grade glioma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22362. [PMID: 36443957 PMCID: PMC9705519 DOI: 10.3171/case22362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial temporal lobe lesion may improve interictal psychotic symptoms that persist despite seizure control remains unknown. OBSERVATIONS In a 52-year-old man with well-controlled epilepsy and persistent comorbid psychosis, brain magnetic resonance imaging (MRI) revealed an infiltrative, intraaxial, T2 fluid-attenuated inversion recovery intense mass of the left amygdala. The patient received an amygdalectomy for oncological diagnosis and surgical treatment of a presumed low-grade glioma. Pathology was ganglioglioma, World Health Organization grade I. Postoperatively, the patient reported immediate resolution of auditory hallucinations. Patient has remained seizure-free on 2 antiepileptic drugs and no antipsychotic pharmacotherapy and reported lasting improvement in his psychotic symptoms. LESSONS This report discusses improvement of psychosis symptoms after resection of an amygdalar glioma, independent of seizure outcome. This case supports a role of the amygdala in psychopathology and suggests that low-grade gliomas of the limbic system may represent, at minimum, partially reversible etiology of psychotic symptoms.
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Affiliation(s)
- John P. Andrews
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - John K. Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Doris D. Wang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Sharma A, Das AK, Jain A, Purohit DK, Solanki RK, Gupta A. Study of Association of Various Psychiatric Disorders in Brain Tumors. Asian J Neurosurg 2022; 17:621-630. [PMID: 36570750 PMCID: PMC9771634 DOI: 10.1055/s-0042-1757437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Achal Sharma
- Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Anand Kumar Das
- Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India,Address for correspondence Anand Kumar Das, MCh Neurosurgery All India Institute of Medical SciencesPhulwari Sharif, Patna, 801507, BiharIndia
| | - Akhilesh Jain
- Department of Psychiatry, ESIC Model Hospital, Jaipur, Rajasthan, India
| | | | - Ram Kumar Solanki
- Department of Psychiatry, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Ajay Gupta
- Department of Preventive and Social Medicine, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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Bytnar JA, Lin J, Theeler BJ, Scher AI, Shriver CD, Zhu K. The relationship between prior psychiatric diagnosis and brain cancer diagnosis in the U.S. military health system. Cancer Causes Control 2022; 33:1135-1144. [PMID: 35838810 DOI: 10.1007/s10552-022-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Prior research suggested the increased likelihood of brain cancer diagnosis following certain psychiatric diagnoses. This association may result from detection bias or suggest an early sign for brain cancer. This study investigated whether psychiatric illness may be an early manifestation of brain cancer while considering potential effects of detection bias. METHODS This case-control study used the data from the Department of Defense's Central Cancer Registry and the Military Health System Data Repository. Four cancer-free controls and one negative-outcome control (cancers not associated with psychiatric illness) were matched to each brain cancer case diagnosed from 1998 to 2013 by age, sex, race, and military status. The groups were compared in the likelihood of having a pre-existing psychiatric diagnosis using conditional logistic regression. RESULTS We found a significant association of psychiatric illnesses with brain cancer (Odds Ratio (OR) = 2.63, 95% confidence interval (CI) = 2.18-3.16) and other cancers (OR = 1.80, 95% CI = 1.49-2.19), compared to non-cancer controls. The association was stronger for psychiatric diagnoses within three months before cancer (brain cancer: OR = 26.77, 95% CI = 15.40-46.53; other cancers: OR = 4.12, 95% CI = 1.96-8.65). The association with psychiatric disorders within 3 months were higher for small brain tumors (OR = 128.32, 95% CI = 17.28-952.92 compared to non-cancer controls) while the OR was 2.79 for other cancers (95% CI = 0.86-8.99 compared to non-cancer controls). CONCLUSION Our findings suggest an association between diagnosed psychiatric illnesses and subsequent brain cancer diagnosis, which may not be solely explained by detection bias. Psychiatric illness might be a sign for early detection of brain cancer beyond the potential effects of detection bias.
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Affiliation(s)
- Julie A Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Jie Lin
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brett J Theeler
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Ann I Scher
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. .,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA. .,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Alves CHL, Alves GS, Ferreira AAMF, Lacerda EMDCB, Tomaz C. Cognitive evaluation following the evolution of brain myofibroblastic tumor in the adolescence: a case study report. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT Objective To report the case of a teenager (12 years old) diagnosed with a brain tumor in the right frontal-parietal region emphasizing the main characteristics observed in neuropsychological examinations. Methods In the pre-surgical evaluation, the patient presented behavioral alterations, including deficits in verbal comprehension, perceptual organization, working memory, processing speed, and slight alterations regarding constructive praxis. Results A reevaluation after two years surgery revealed significant improvement in verbal and perceptual comprehension and constructive praxis while remaining a slight change in processing speed. These results suggest that the tumor’s surgical resection produced significant improvements in the patient’s neurocognitive context, especially in executive functions. This study also indicates that Neuropsychological evaluation are useful for pre- and post- surgical evaluation of cognitive functioning and its evolution. Conclusion Brain tumor causes cognitive and behavioral changes and its resection can result in improvements in the patient’s quality of life.
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Denisova NP, Rzaev JA. Psychiatric mimics of neurosurgical disorders. PROGRESS IN BRAIN RESEARCH 2022; 272:153-171. [PMID: 35667800 DOI: 10.1016/bs.pbr.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Every year there are about 22.6 million people in need of neurosurgical care around the world, and one or several interventions are required to save lives and restore functional losses in more than half of these cases (13.8 million). Most neurosurgical interventions are performed in patients with traumatic brain and spinal cord injuries, strokes, central nervous system (CNS) tumors, hydrocephalus, and epilepsy. In addition to neurological symptoms, many CNS disorders are often accompanied by cognitive and/or behavioral changes. Physical and psychological symptoms can be intertwined as follows: 1) neurological symptoms may be manifested as a result of complex psychological processes; 2) psychological disorders may be manifested as neurological symptoms; 3) neurological disorders commonly cause secondary psychological responses; 4) psychological disorder may be induced more or less directly by an organic brain disease. In the present paper, we focus on the psychiatric conditions occurring in the patients with neurosurgical disorders who either get prepared for surgery or have already received it.
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Affiliation(s)
| | - Jamil A Rzaev
- Federal Neurosurgical Center, Novosibirsk, Russian Federation.
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Abstract
OBJECTIVE Neuropsychiatric disorders in brain tumor patients are commonly observed. It is difficult to anticipate these disorders in different types of brain tumors. The goal of the study was to see how well machine learning (ML)-based decision algorithms might predict neuropsychiatric problems in different types of brain tumors. METHODS 145 histopathologically-confirmed primary brain tumors of both gender aged 25-65 years of age, were included for neuropsychiatric assessments. The datasets of brain tumor patients were employed for building the models. Four different decision ML classification trees/models (J48, Random Forest, Random Tree & Hoeffding Tree) with supervised learning were trained, tested, and validated on class labeled data of brain tumor patients. The models were compared in order to determine the best accurate classifier in predicting neuropsychiatric problems in various brain tumors. Following categorical attributes as independent variables (predictors) were included from the data of brain tumor patients: age, gender, depression, dementia, and brain tumor types. With the machine learning decision tree/model techniques, a multi-target classification was performed with classes of neuropsychiatric diseases that were predicted from the selected attributes. RESULTS 86 percent of patients were depressed, and 55 percent were suffering from dementia. Anger was the most often reported neuropsychiatric condition in brain tumor patients (92.41%), followed by sleep disorders (83%), apathy (80%), and mood swings (76.55%). When compared to other tumor types, glioblastoma patients had a higher rate of depression (20%) and dementia (20.25%). The developed models Random Forest and Random Tree were found successful with an accuracy of up to 94% (10-folds) for the prediction of neuropsychiatric disorders in brain tumor patients. The multiclass target (neuropsychiatric ailments) accuracies were having good measures of precision (0.9-1.0), recall (0.9-1.0), F-measure (0.9-1.0), and ROC area (0.9-1.0) in decision models. CONCLUSION Random Forest Trees can be used to accurately predict neuropsychiatric illnesses. Based on the model output, the ML-decision trees will aid the physician in pre-diagnosing the mental issue and deciding on the best therapeutic approach to avoid subsequent neuropsychiatric issues in brain tumor patients.
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Affiliation(s)
- Saman Shahid
- Department of Sciences & Humanities, National University of Computer & Emerging Sciences (NUCES), Foundation for Advancement of Science and Technology (FAST), Lahore, Pakistan
| | - Sadaf Iftikhar
- Department of Neurology, King Edward Medical University (KEMU), Mayo Hospital, Lahore, Pakistan
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Sherman SJ, Tanaka R, Qaddoumi I. Psychiatric symptoms in children with low-grade glioma and craniopharyngioma: A systematic review. J Psychiatr Res 2022; 148:240-249. [PMID: 35149436 DOI: 10.1016/j.jpsychires.2022.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
The presentation of psychiatric symptoms in pediatric low-grade brain tumors is challenging because this can delay proper diagnosis and treatment. We performed a systematic review of psychiatric presenting symptoms of low-grade brain tumors in pediatric patients. We searched the PubMed and Web of Science databases of studies published in English from 1977 until 2019 reporting patients aged ≤21 years at the time of tumor diagnosis who exhibited psychiatric/behavioral symptoms before diagnosis of low-grade glioma (LGG), pilocytic astrocytoma (PA), or craniopharyngioma (CP). Our systematic search strategy coupled each tumor type with patient age and presenting symptoms by using different variations of the search terms "childhood" and "psychiatric symptoms" or "behavioral symptoms." We identified six unique articles that met our inclusion criteria in the LGG search, 27 in the PA search, and 32 in the CP search. Six patients were included in the LGG articles (age range, 3-16 years), 75 in the PA articles (age range, 0.5-21 years), and 87 in the CP articles (age range, 0.67-21 years). The most common presenting symptoms included eating disorders (n = 64) and behavioral changes (n = 49). Our findings demonstrate the need to establish clear criteria for neuroimaging indications for pediatric patients exhibiting eating disorders.
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Affiliation(s)
- Sarah J Sherman
- St. Jude Children's Research Hospital Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ryuma Tanaka
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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14
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Javadi SAHS, Rezaei B. Brain tumors and indications for brain imaging in patients with psychiatric manifestations: a case report. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00136-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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15
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Lee TY, Jo HJ. Differential diagnosis and comorbid physical illness of schizophrenia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.8.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Schizophrenia is a neurodevelopmental disorder that generally develops during adolescence or early adulthood. However, differentiating it from psychosis caused by a physical illness is difficult due to the phenotypebased diagnostic system. In this review, differential diagnosis of schizophrenia and the comorbid physical illnesses of patients with schizophrenia will be discussed.Current Concepts: Psychotic symptoms can be caused by various physical illnesses, and patients with schizophrenia have many physical comorbidities. Symptoms of psychosis can also be expressed by physical illness including brain tumors, encephalitis, temporal lobe epilepsy, autoimmune disease, and genetic disease. For the differential diagnosis of other physical illnesses that can cause psychosis, biological tests are essential. Depending on the cause, antipsychotics and treatment of physical diseases are required. In addition, patients with schizophrenia have many comorbid medical conditions such as obesity, diabetes, cardiovascular disease, but the diagnosis rate is low, and the mortality is higher than that of the general population due to untreated medical diseases.Discussion and Conclusion: The differential diagnoses of schizophrenia and physical illness causing psychosis are important. To decrease the high mortality of patients with schizophrenia, periodic physical condition examinations and mental status examinations should be conducted.
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16
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Bowers AR, Hughes L. Craniopharyngioma presenting with psychiatric symptoms: a case report. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2021. [DOI: 10.1002/pnp.715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alexis R Bowers
- Dr Bowers is Consultant Psychiatrist and Dr Hughes is a Locum Senior House Officer, both at the Sevenacres acute psychiatric inpatient unit at the Isle of Wight NHS Trust
| | - Lewis Hughes
- Dr Bowers is Consultant Psychiatrist and Dr Hughes is a Locum Senior House Officer, both at the Sevenacres acute psychiatric inpatient unit at the Isle of Wight NHS Trust
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17
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The role of MRI and CT of the brain in first episodes of psychosis and behavioural abnormality. Clin Radiol 2021; 76:712.e9-712.e13. [PMID: 34099260 DOI: 10.1016/j.crad.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/05/2021] [Indexed: 11/20/2022]
Abstract
AIM To investigate whether computed tomography (CT)/magnetic resonance imaging (MRI) brain imaging is associated with detection of structural causes of a first episode of psychosis (FEP) or first episode of behavioural abnormality (FEB) in the paediatric population, as this has not been previously documented in the literature. MATERIALS AND METHODS Individuals with FEP/FEB but no neurological signs referred to a tertiary children's centre for cerebral MRI or CT were reviewed retrospectively. Individuals were evaluated independently with one technique (CT or MRI) only. RESULTS Thirty-four consecutive cerebral MRI and six consecutive CT examinations were identified between 2017 and 2020. No patients were identified as having an organic cause for the psychosis at MRI or CT. Four patients (9%) had incidental findings on MRI, unrelated to the psychosis, such as prominent perivascular spaces, hypoplastic transverse sinus, and sinonasal mucosal wall thickening. No abnormal findings were seen on CT. There was therefore no obvious difference between MRI and CT imaging in detecting organic disease potentially responsible for FEP. CONCLUSION Routine structural MRI or CT of the brain is unlikely to reveal disease leading to a significant change in management. MRI demonstrated only a few incidental findings, unrelated to the child's clinical history. Therefore, routine brain structural imaging of FEP/FEB in paediatric patients without focal neurology may not be routinely required. If imaging is requested, then there is no significant difference between CT and MRI in detecting clinically significant lesions.
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18
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Ghandour F, Squassina A, Karaky R, Diab-Assaf M, Fadda P, Pisanu C. Presenting Psychiatric and Neurological Symptoms and Signs of Brain Tumors before Diagnosis: A Systematic Review. Brain Sci 2021; 11:301. [PMID: 33673559 PMCID: PMC7997443 DOI: 10.3390/brainsci11030301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Fatima Ghandour
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
- EDST, Pharmacology and Cancerology Laboratory, Faculty of Sciences, Lebanese University, Beirut 1500, Lebanon;
| | - Alessio Squassina
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
| | - Racha Karaky
- Drug-Related Sciences Department, Faculty of Pharmacy, Lebanese University, Hadath 1500, Lebanon;
| | - Mona Diab-Assaf
- EDST, Pharmacology and Cancerology Laboratory, Faculty of Sciences, Lebanese University, Beirut 1500, Lebanon;
| | - Paola Fadda
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
- Centre of Excellence “Neurobiology of Addiction”, University of Cagliari, 09042 Monserrato, Italy
- CNR Institute of Neuroscience-Cagliari, National Research Council, 09042 Monserrato, Italy
- National Institute of Neuroscience (INN), 10126 Turin, Italy
| | - Claudia Pisanu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, 09042 Monserrato, Italy; (F.G.); (A.S.); (C.P.)
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19
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Visual hallucinations as psychiatric onset of a primary central nervous system lymphoma: a case report and a brief review of literature on neoplasm-correlated neuropsychiatric disorders. Neurol Sci 2020; 41:3747-3749. [DOI: 10.1007/s10072-020-04508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
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20
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Byrne A, Henry S. Meningioma and psychosis – cause or coincidence? PROGRESS IN NEUROLOGY AND PSYCHIATRY 2020. [DOI: 10.1002/pnp.672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andrew Byrne
- Dr Byrne is a Consultant Old Age Psychiatrist, at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
| | - Sarah Henry
- Dr Henry is a Psychiatry ST5 Doctor in Old Age Psychiatry, at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
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21
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Abstract
Brain tumors' severity ranges from benign to highly aggressive and invasive. Bioengineering tools can assist in understanding the pathophysiology of these tumors from outside the body and facilitate development of suitable antitumoral treatments. Here, we first describe the physiology and cellular composition of brain tumors. Then, we discuss the development of three-dimensional tissue models utilizing brain tumor cells. In particular, we highlight the role of hydrogels in providing a biomimetic support for the cells to grow into defined structures. Microscale technologies, such as electrospinning and bioprinting, and advanced cellular models aim to mimic the extracellular matrix and natural cellular localization in engineered tumor tissues. Lastly, we review current applications and prospects of hydrogels for therapeutic purposes, such as drug delivery and co-administration with other therapies. Through further development, hydrogels can serve as a reliable option for in vitro modeling and treatment of brain tumors for translational medicine.
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22
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Suradom C, Suttajit S, Soontornpun A, Pinyopornpanish M. Frontal lobe meningioma presenting with schizophrenia-like symptoms: an organic cause of psychotic disorder. BMJ Case Rep 2020; 13:13/4/e234526. [PMID: 32350055 DOI: 10.1136/bcr-2020-234526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 51-year-old woman had been diagnosed and treated for schizophrenia for 10 years. Two weeks prior to admission, she developed headache and diplopia. Then, she was found unconscious and was sent to the hospital. A tumour in the left frontal lobe of the brain, causing brain herniation, was diagnosed and surgical excision of tumour was performed immediately. The psychotic symptoms of the patient were completely resolved after surgery. The histological diagnosis was meningioma. This case demonstrates an uncommon presentation of meningioma, the most common primary brain tumour. Patients presenting with psychotic symptoms may be misdiagnosed with schizophrenia, when a tumour is present, allowing the tumour to grow and causing associated complications. Early diagnosis and treatment could prevent mortality and morbidity. The treating physician should be aware of organic possibilities and carefully search for atypical presentations of psychiatric disorders in their patients.
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Affiliation(s)
- Chawisa Suradom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atiwat Soontornpun
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Manee Pinyopornpanish
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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23
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Leo RJ, Frodey JN, Ruggieri ML. Subtle neuropsychiatric symptoms of glioblastoma multiforme misdiagnosed as depression. BMJ Case Rep 2020; 13:13/3/e233208. [PMID: 32188609 DOI: 10.1136/bcr-2019-233208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Raphael Jerome Leo
- Department of Psychiatry, SUNY at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jill N Frodey
- Department of Psychiatry, SUNY at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Matthew L Ruggieri
- Department of Psychiatry, SUNY at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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24
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Corbet Burcher G, Liang H, Lancaster R, Cross JH, Tisdall M, Varadkar S, Spoudeas HA, Caredda E, Bennett S, Heyman I. Neuropsychiatric profile of paediatric hypothalamic hamartoma: systematic review and case series. Dev Med Child Neurol 2019; 61:1377-1385. [PMID: 30977116 DOI: 10.1111/dmcn.14241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/22/2022]
Abstract
AIM To evaluate neuropsychiatric comorbidities in children and adolescents with hypothalamic hamartoma. METHOD We retrospectively analysed case notes for all individuals with hypothalamic hamartoma referred to Great Ormond Street Hospital, London, between 2000 and 2016. In addition, a systematic review aiming to identify all previous paediatric case series was performed. Psychiatric symptoms, demographics, physical comorbidities, and cognitive functioning were recorded for all cases where possible. Analyses were performed to determine which factors were associated with psychopathology and potential mechanisms investigated. RESULTS Forty-six cases were included in the case series (28 males, 18 females; mean age at assessment 11y 8mo [1y 11mo-16y 11mo, SD 4y 0mo]). Twenty-nine papers representing data from 264 cases met inclusion criteria for the systematic review. Overall, at least 50% of cases presented with psychopathology. Epilepsy, intellectual disability, and male sex were associated with externalizing disorders (attention-deficit/hyperactivity disorder, conduct and oppositional defiance disorders, and rage attacks). Intellectual disability mediated the effects of epilepsy on externalizing psychopathology. No factors were associated with internalizing disorders (anxiety and depressive disorders), although these were not well reported. INTERPRETATION Psychiatric comorbidities are highly prevalent in the presentation of paediatric hypothalamic hamartoma. The aetiology of psychopathology comprises a range of interacting biological and psychosocial factors with particular influence from epilepsy. Further research is required to achieve an evidence base for treatment. WHAT THIS PAPER ADDS Over half of children with hypothalamic hamartoma present with psychiatric comorbidity. Externalizing and internalizing disorders are present in approximately 60% and 30% of children with hypothalamic hamartomas respectively. Epilepsy and male sex are associated with externalizing psychopathology. Intellectual disability mediates the association between epilepsy and externalizing symptoms. No clear associations are evident for internalizing disorders or precocious puberty.
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Affiliation(s)
- Georgina Corbet Burcher
- Department of Child and Adolescent Psychiatry, Centre for Psychiatry, Imperial College London, London, UK
| | - Holan Liang
- Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rebecca Lancaster
- Department of Child and Adolescent Psychiatry, Centre for Psychiatry, Imperial College London, London, UK
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Martin Tisdall
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Sophia Varadkar
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Helen A Spoudeas
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Paediatric Neuroendocrinology, Great Ormond Street Hospital for Children and University College Hospital, London, UK
| | - Elisabetta Caredda
- Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Sophie Bennett
- Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Isobel Heyman
- Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
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25
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Callari A, Miniati M. Clinical and Therapeutic Challenges when Psychiatric Disorders Occur in Neurological Diseases: A Narrative Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190411142109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Over the course of the 20th century, neurology and psychiatry diverged and became two separate disciplines. Subsequently, the continuous progress of neurosciences confused their boundaries. However, with ‘the splitting’ and ‘the lumping’ approaches, relevant difficulties remain in targeting clinical and therapeutic goals, when psychiatric signs and symptoms co-occur with neurological diseases.Objective:The study summarize current evidence on psychiatric signs and symptoms comorbid with neurological diseases, with the aim to provide information on diagnostic problems and available therapeutic options.Methods:Finding from searches of publications on ‘PsycInfo’, ‘Medline’, and ‘Science Direct’, from January 1993 to December 2018 (25 years) is summarized in a narrative manner on six main neurological areas: congenital neurological illnesses (n=16), dementias (n=15), basal ganglia diseases (n=30), epilepsy (n=22), strokes/focal brain injuries (n=29), and neurological neoplastic/paraneoplastic diseases (n=15).Results:Clinical phenotypes of psychiatric syndromes are frequently described in neurological studies. Little evidence is provided on the most adequate therapeutic approaches.Conclusion:Psychiatric syndromes in comorbidity with neurological diseases are heterogeneous and severe; evidence-based treatments are scarce. Despite a model supporting an equal approach between psychiatric and neurological syndromes, psychiatric syndromes in neurological diseases have been described, to a relevant degree, as less important, leading to a hierarchical primate of the neurological manifestations, and thus, in our opinion, limiting the systematic studies on psychopharmacological treatments in this area.
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Affiliation(s)
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
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26
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Abstract
The objective of this article is to describe the possible association of catatonia and temporal brain lesions. This is a case presentation of a 57-year-old man presenting with depression, with catatonia secondary to a temporal glioblastoma. He was referred to hospital because for a sudden deterioration in depressed state. He was diagnosed with catatonia and treated successfully with lorazepam. During his admission, he became increasingly disinhibited, and an MRI scan revealed an intracranial mass in the right temporal lobe, with uncal herniation and a mass effect. Surgical resection of the entire tumour was successful. Histological examination revealed a glioblastoma multiforme requiring additional chemoradiotherapy. Postoperatively, catatonic signs and symptoms were not detectable. A postsurgical frontal syndrome with disinhibition and logorrhoea was present and gradually normalised over the course of several weeks. Catatonia can be the presenting symptom of a temporal brain tumour, and should therefore prompt the physician to a thorough medical investigation.
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Affiliation(s)
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium
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27
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Trevizol AP, Cerqueira RDO, Brietzke E, Cordeiro Q. New-onset psychiatric symptoms following intracranial meningioma in a patient with schizophrenia: a case study. BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 41:91-92. [PMID: 30758462 PMCID: PMC6781699 DOI: 10.1590/1516-4446-2018-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/04/2018] [Indexed: 11/25/2022]
Affiliation(s)
| | - Raphael de O Cerqueira
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elisa Brietzke
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Quirino Cordeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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28
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Madhusoodanan S, Ting MB, Wilson SY. The psychopharmacology of primary and metastatic brain tumors and paraneoplastic syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:269-283. [PMID: 31727217 DOI: 10.1016/b978-0-444-64012-3.00016-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
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.
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Affiliation(s)
- Subramoniam Madhusoodanan
- Department of Psychiatry, St. John's Episcopal Hospital, New York, NY, United States; Department of Psychiatry, SUNY Health Science Center at Brooklyn, New York, NY, United States.
| | - Mark Bryan Ting
- Community Behavioral Health Center, Fresno, CA, United States
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29
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Petzold J, Severus E, Meyer S, Bauer M, Daubner D, Krex D, Juratli TA. Glioblastoma multiforme presenting as postpartum depression: a case report. J Med Case Rep 2018; 12:374. [PMID: 30567605 PMCID: PMC6300872 DOI: 10.1186/s13256-018-1909-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/30/2018] [Indexed: 01/02/2023] Open
Abstract
Background Alterations of mental status are characteristic of psychiatric disorders but may also result from a multitude of organic causes. Generally, physical examination and blood analysis are a part of basic psychiatric differential diagnostics, whereas more sophisticated procedures (for example, brain imaging) are applied only in cases with pathologic diagnostic findings. Our report challenges this approach by describing a case of glioblastoma multiforme presenting as postpartum depression without abnormalities in basic differential diagnostics. Case presentation A 28-year-old white woman who had been in outpatient treatment for postpartum depression was taken to the psychiatric emergency room. The psychopathological assessment, however, showed mild disorientation and severe deficits of long-term memory. Moreover, she complained of stabbing, bilateral headaches, but results of her physical examination and blood analysis were unremarkable. Magnetic resonance imaging of the brain was performed, which showed a contrast-enhanced mass lesion in the left frontal lobe. The patient underwent urgent tumor resection, and histologic results revealed an IDH-mutant glioblastoma multiforme. The patient was discharged with a substantially improved psychopathology and without neurological deficits. Conclusions This report adds to the evidence that postpartum depression may have organic causes in some cases, a fact that needs to be considered in the clinical setting. Atypical neurocognitive findings in a psychiatric interview may alone justify brain imaging, despite normal physical examination and blood analysis results.
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Affiliation(s)
- Johannes Petzold
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany.
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Shirin Meyer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Dirk Daubner
- Institute of Neuroradiology, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Tareq A Juratli
- Department of Neurosurgery, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
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Abstract
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.
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Kohli KM, Loewenstern J, Kessler RA, Pain M, Palmese CA, Bederson J, Shrivastava RK. Antidepressant use in patients with meningioma: is there an association with tumor recurrence? Neurosurg Focus 2018; 44:E14. [DOI: 10.3171/2018.3.focus17797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEWith increasing general use of antidepressants (ADs), multiple studies have noted a small protective effect of ADs for patients with glioma, but their impact on meningioma has not been established. This study aims to evaluate the role of ADs in the context of additional clinical factors in relation to long-term risk of meningioma recurrence.METHODSOne hundred five patients with an intracranial meningioma presenting from 2011–2014 with at least 3 years of follow-up (median 4.2 years) after resection were reviewed. AD use along with demographics, tumor characteristics, and outcomes were recorded. Multivariate logistic regression was used to analyze the association of AD use with tumor recurrence, including other clinical measures significantly associated with recurrence as covariates.RESULTSTwenty-nine patients (27.4%) were taking ADs (27 selective serotonin reuptake inhibitors, 2 norepinephrine-dopamine reuptake inhibitors) prior to tumor recurrence. Their tumors largely affected the frontal (31.0%) or parietal lobe (17.2%) and were located in convexity, parasagittal, or falcine (CPF) areas more frequently than skull base areas relative to the tumors of non-AD users (p = 0.035). AD use was found to be an independent predictor of recurrence, in addition to subtotal resection and WHO grade II/III classification (p values < 0.05). The median time from AD prescription to tumor recurrence was 36.6 months (interquartile range [IQR] = 20.9–62.9 months) and median length of AD use was 41.4 months (IQR = 24.7–62.8 months).CONCLUSIONSAD use was an independent predictor of meningioma recurrence. This association may be due to mood or affective changes caused by tumor location in CPF regions that may be a sign of early recurrence. The finding calls attention to AD use in the management of patients with meningioma, and warrants further exploration of an underlying relationship.
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Affiliation(s)
| | | | | | | | | | | | - Raj K. Shrivastava
- Departments of 1Neurosurgery,
- 4Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
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Brain tumour masquerading as bereavement in a 50 year old woman. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Carmona-Bayonas A, Jiménez-Fonseca P, Vázquez Olmos C, Vega Villar J. Hyperreligiosity in malignant brain tumors: a case report and accompanying bibliographic review. Neurocase 2017; 23:88-95. [PMID: 27938192 DOI: 10.1080/13554794.2016.1265985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Religion is a complex cognitive process with biopsychosocial and cultural dimensions, product of the activation of different circuits of the neocortex. In some cases, religiosity can appear as a pathological correlate in patients with brain lesions in the areas involved. We present the clinical case of a patient with an astrocytoma in the right prefrontal region, with apparent inflammatory involvement of the right temporal lobe. This tumor debuted almost exclusively as an alteration of personality consisting of hyperreligiosity, logorrhea, and mystical experiences. A review of the literature has been conducted and possible pathophysiological mechanisms are proposed.
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Affiliation(s)
- Alberto Carmona-Bayonas
- a Department of Hematology & Medical Oncology , Hospital Universitario Morales Meseguer , Murcia , Spain
| | | | - Carlos Vázquez Olmos
- c Radiology Service, Neuro-radiology Section , Hospital Universitario Morales Meseguer , Murcia , Spain
| | - Juan Vega Villar
- d Radiology Service , Hospital Universitario de Getafe , Madrid , Spain.,e Department of Neurology , Hospital Universitario Central de Asturias , Oviedo , Spain
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Tringale KR, Wilson BR, Hirshman B, Zhou T, Folsom D, Norman MA, Grant I, Chen CC, Carter BS. Psychiatric Disease Preceding Intracranial Tumor Diagnosis: Investigating the Association. Prim Care Companion CNS Disord 2016; 18. [PMID: 28002663 DOI: 10.4088/pcc.16m02028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022] Open
Abstract
Objective Here, we examine rates of intracranial tumor diagnoses in patients with and without comorbid psychiatric diagnoses to better understand how psychiatric disease may alter risk profiles for brain tumor diagnosis. Methods We used a longitudinal version of the California Office of Statewide Health Planning and Development (OSHPD) database, which includes all inpatient admissions in California from 1995 to 2010. We examined patients with confirmed hospital admissions from 1997 to 2004. Patients with an intracranial tumor or psychiatric diagnosis on their first hospital admission were excluded. The primary outcome of interest was the diagnosis of intracranial tumor on any subsequent hospitalization within 5 years. Risk of tumor diagnosis was determined via Cox proportional hazard models adjusted for age, gender, race/ethnicity, and comorbidity burden. Subset analyses were performed for various tumor types. Results The risk for diagnosis of an intracranial tumor within 5 years, as determined by the hazard ratio, was 1.61 (95% CI, 1.28-2.04) for bipolar, 1.59 (95% CI, 1.41-1.72) for anxious, and 1.34 (95% CI, 1.25-1.43) for depressed cohorts relative to controls. More specifically, the risk for diagnosis of a primary benign neoplasm was elevated in depressed patients, while the risk for diagnosis of a meningioma was elevated in depressed, anxious, and bipolar disorder patients. Conclusions Patients admitted with certain psychiatric diagnoses appear more likely to be readmitted within 5 years with specific types of intracranial tumor diagnoses. The association between certain psychiatric diagnoses and subsequent brain tumor diagnosis most likely reflects the long-held belief that slow-growing tumors may first present as psychiatric symptoms before being diagnosed. Primary care physicians should consider the possibility of an underlying intracranial tumor in patients with new psychiatric diagnoses.
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Affiliation(s)
- Kathryn R Tringale
- School of Medicine, University of California, San Diego, California, USA
| | - Bayard R Wilson
- School of Medicine, University of California, San Diego, California, USA
| | - Brian Hirshman
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Tianzan Zhou
- School of Medicine, University of California, San Diego, California, USA
| | - David Folsom
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Marc A Norman
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Clark C Chen
- Department of Neurosurgery, University of California, San Diego, California, USA
| | - Bob S Carter
- Department of Neurosurgery, University of California, San Diego, CA. .,Department of Neurosurgery, University of California, San Diego, California, USA
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Freitas RB, González P, Martins NMB, Andrade ER, Cesteros Morante MJ, Conles Picos I, Costilla García S, Bauermann LF, Barrio JP. Ameliorative effect of black grape juice on systemic alterations and mandibular osteoradionecrosis induced by whole brain irradiation in rats. Int J Radiat Biol 2016; 93:204-213. [PMID: 27600691 DOI: 10.1080/09553002.2017.1231945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Whole brain irradiation (WBI) causes a variety of secondary side-effects including anorexia and bone necrosis. We evaluated the radiomodifying effect of black grape juice (BGJ) on WBI alterations in rats measuring food and water intake, body weight, hemogram, and morphological and histological mandibular parameters. MATERIALS AND METHODS Forty male rats (200-250 g) were exposed to eight sessions of cranial X-ray irradiation. The total dose absorbed was 32 Gy delivered over 2 weeks. Four groups were defined: (i) NG: non-irradiated, glucose and fructose solution-supplemented (GFS); (ii) NJ: non-irradiated, BGJ-supplemented; (iii) RG: irradiated, GFS-supplemented; and (iv) RJ: irradiated, BGJ-supplemented. Rats received daily BGJ or GFS dosing by gavage starting 4 days before, continuing during, and ending 4 days after WBI. RESULTS RJ rats ingested more food and water and showed less body weight loss than RG rats during the irradiation period. Forty days after WBI, irradiated animals started losing weight again compared with controls as a consequence of masticatory hypofunction by mandibular osteoradionecrosis (ORN). Osteoclastic activity and inflammation were apparent in RG rat mandibles. BGJ was able to attenuate the severity of ORN as well as to improve white and red blood cell counts. CONCLUSIONS Fractionated whole brain irradiation induces mandibular changes that interfere with normal feeding. BGJ can be used to mitigate systemic side-effects of brain irradiation and ORN.
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Affiliation(s)
- Robson B Freitas
- a Post-graduate program in Pharmaceutical Sciences, University of Santa Maria , Santa Maria , Rio Grande do Sul , Brazil
| | - Paquita González
- b Department of Biomedical Sciences , University of León , León , Spain
| | - Nara Maria B Martins
- c Department of Pathology , University of Santa Maria , Santa Maria , Rio Grande do Sul , Brazil
| | - Edson R Andrade
- d Nuclear Engineering Program, Military Institute of Engineering , Rio de Janeiro , Rio de Janeiro , Brazil
| | | | - Iban Conles Picos
- e Servicio de Radiofísica y Protección Radiológica, Hospital Universitario de León , León , Spain
| | | | - Liliane F Bauermann
- g Department of Physiology and Pharmacology , University of Santa Maria , Santa Maria , Rio Grande do Sul , Brazil
| | - Juan Pablo Barrio
- b Department of Biomedical Sciences , University of León , León , Spain
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Satzer D, Bond DJ. Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder. Bipolar Disord 2016; 18:205-20. [PMID: 27112231 DOI: 10.1111/bdi.12387] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Approximately 3.5 million Americans will experience a manic episode during their lifetimes. The most common causes are psychiatric illnesses such as bipolar I disorder and schizoaffective disorder, but mania can also occur secondary to neurological illnesses, brain injury, or neurosurgical procedures. METHODS For this narrative review, we searched Medline for articles on the association of mania with stroke, brain tumors, traumatic brain injury, multiple sclerosis, neurodegenerative disorders, epilepsy, and neurosurgical interventions. We discuss the epidemiology, features, and treatment of these cases. We also review the anatomy of the lesions, in light of what is known about the neurobiology of bipolar disorder. RESULTS The prevalence of mania in patients with brain lesions varies widely by condition, from <2% in stroke to 31% in basal ganglia calcification. Mania occurs most commonly with lesions affecting frontal, temporal, and subcortical limbic brain areas. Right-sided lesions causing hypo-functionality or disconnection (e.g., stroke; neoplasms) and left-sided excitatory lesions (e.g., epileptogenic foci) are frequently observed. CONCLUSIONS Secondary mania should be suspected in patients with neurological deficits, histories atypical for classic bipolar disorder, and first manic episodes after the age of 40 years. Treatment with antimanic medications, along with specific treatment for the underlying neurologic condition, is typically required. Typical lesion locations fit with current models of bipolar disorder, which implicate hyperactivity of left-hemisphere reward-processing brain areas and hypoactivity of bilateral prefrontal emotion-modulating regions. Lesion studies complement these models by suggesting that right-hemisphere limbic-brain hypoactivity, or a left/right imbalance, may be relevant to the pathophysiology of mania.
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Affiliation(s)
- David Satzer
- Medical School, University of Minnesota, Minneapolis, MN, USA
| | - David J Bond
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Madhusoodanan S, Ting MB, Farah T, Ugur U. Psychiatric aspects of brain tumors: A review. World J Psychiatry 2015; 5:273-285. [PMID: 26425442 PMCID: PMC4582304 DOI: 10.5498/wjp.v5.i3.273] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/02/2015] [Accepted: 09/08/2015] [Indexed: 02/05/2023] Open
Abstract
Infrequently, psychiatric symptoms may be the only manifestation of brain tumors. They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety, or anorexia. Symptoms may be misleading, complicating the clinical picture. A comprehensive review of the literature was conducted regarding reports of brain tumors and psychiatric symptoms from 1956-2014. Search engines used include PubMed, Ovid, Psych Info, MEDLINE, and MedScape. Search terms included psychiatric manifestations/symptoms, brain tumors/neoplasms. Our literature search yielded case reports, case studies, and case series. There are no double blind studies except for post-diagnosis/-surgery studies. Early diagnosis is critical for improved quality of life. Symptoms that suggest work-up with neuroimaging include: new-onset psychosis, mood/memory symptoms, occurrence of new or atypical symptoms, personality changes, and anorexia without body dysmorphic symptoms. This article reviews the existing literature regarding the diagnosis and management of this clinically complex condition.
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Boele FW, Rooney AG, Grant R, Klein M. Psychiatric symptoms in glioma patients: from diagnosis to management. Neuropsychiatr Dis Treat 2015; 11:1413-20. [PMID: 26089669 PMCID: PMC4467748 DOI: 10.2147/ndt.s65874] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with primary intrinsic brain tumors can experience neurological, cognitive, and psychiatric symptoms that greatly affect daily life. In this review, we focus on changes in personality and behavior, mood issues, hallucinations, and psychosis, because these are either difficult to recognize, to treat, or are understudied in scientific literature. Neurobehavioral symptoms are common, often multiple, and causation can be multifactorial. Although different symptoms sometimes require a different treatment approach, we advise a comprehensive treatment approach, including pharmacological treatment and/or psychotherapy where appropriate. Further research is needed to obtain a better estimate of the prevalence of psychiatric symptoms in glioma patients, and the extent to which these affect everyday functioning and family life.
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Affiliation(s)
- Florien W Boele
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
| | - Alasdair G Rooney
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Robin Grant
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Martin Klein
- Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands
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Abstract
The major features in eating disorders are a preoccupation with food and its consumption and body dissatisfaction. Diagnostic manuals provide clusters of criteria according to which affected individuals can be categorized into one or other group of eating disorder. Yet, when considering the high proportion of comorbidities and ignoring the content of the symptoms (food, body), the major features seem to yield obsessional-compulsive, addictive, and impulsive qualities. In the present article, we review studies from the neuroscientific literature (mainly lesion studies) on eating disorder, obsessive-compulsive disorder, impulse control disorder, and addiction to investigate the possibility of a wider phenotype that can be related to a common brain network. The literature localizes this network to the right frontal lobe and its connectivities. This network, when dysfunctional, might result in a behavior that favors the preoccupation with particular thoughts, behaviors, anxieties, and uncontrollable urges that are accompanied by little scope for ongoing behavioral adjustments (e.g., impulse control). We reason that this network may turn out to be equally involved in understudied mental conditions of dysfunctional body processing such as muscle dysmorphia, body dysmorphic disorder (including esthetic surgery), and xelomelia. We finally consider previous notions of a wider phenotype approach to current diagnostic practice (using DSM), such as the possibility of a model with a reduced number of diagnostic categories and primary and secondary factors, and to etiological models of mental health conditions.
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Affiliation(s)
- Christine Mohr
- Institute of Psychology, University of Lausanne, Switzerland
| | - Sabrina Messina
- Institute of Psychology, University of Lausanne, Switzerland
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Reinert C, Kremmler L, Burock S, Bogdahn U, Wick W, Gleiter CH, Koller M, Hau P. Quantitative and qualitative analysis of study-related patient information sheets in randomised neuro-oncology phase III-trials. Eur J Cancer 2013; 50:150-8. [PMID: 24103146 DOI: 10.1016/j.ejca.2013.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/07/2013] [Accepted: 09/08/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In randomised controlled trials (RCTs), patient informed consent documents are an essential cornerstone of the study flow. However, these documents are often oversized in format and content. Clinical experience suggests that study information sheets are often not used as an aid to decision-making due to their complexity. MATERIAL AND METHODS We analysed nine patient informed consent documents from clinical neuro-oncological phase III-studies running at a German Brain Tumour Centre with the objective to investigate the quality of these documents. Text length, formal layout, readability, application of ethical and legal requirements, scientific evidence and social aspects were used as rating categories. Results were assessed quantitatively by two independents investigators and were depicted using net diagrams. RESULTS All patient informed consent documents were of insufficient quality in all categories except that ethical and legal requirements were fulfilled. Notably, graduate levels were required to read and understand five of nine consent documents. DISCUSSION Quality deficits were consistent between the individual study information texts. Irrespective of formal aspects, a document that is intended to inform and motivate patients to participate in a study needs to be well-structured and understandable. We therefore strongly mandate to re-design patient informed consent documents in a patient-friendly way. Specifically, standardised components with a scientific foundation should be provided that could be retrieved at various times, adapted to the mode of treatment and the patient's knowledge, and could weigh information dependent of the stage of treatment decision.
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Affiliation(s)
- Christiane Reinert
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Lukas Kremmler
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Susen Burock
- EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Ulrich Bogdahn
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany
| | - Wolfgang Wick
- Division of Neuro Oncology, University of Heidelberg and National Center for Tumor Diseases, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Christoph H Gleiter
- CenTrial GmbH, University Hospital Tübingen, Paul-Ehrlich-Str. 5, 72076 Tübingen, Germany
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Franz Josef Strauß-Allee 11, 93047 Regensburg, Germany.
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Abecassis IJ, Smith T, Chandler JP. Brain tumors and the area postrema. J Clin Neurosci 2013; 20:1795-7. [PMID: 24035420 DOI: 10.1016/j.jocn.2013.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/18/2022]
Abstract
Brain tumors can rarely present with symptoms mistaken for anorexia nervosa. We report a patient with a long-standing history of anorexia who developed headaches and was found on brain MRI to have a brain tumor in the area of the fourth ventricle. On admission, the patient presented with a 4 month history of headaches and a 10 year history of "anorexia nervosa". Interestingly, the patient did not endorse the classic sense of an altered self-body image. Her body weight on admission was 37 kg. The patient underwent surgical resection of the tumor. On postoperative day (POD) 1, the patient subjectively reported an increased appetite. On POD 2, we documented that she finished her entire food tray for the first time during her hospital stay. Her peri-operative course was without any complications. She presented for a follow-up clinic visit 2 weeks postoperatively and was noted to have a new body weight of 47 kg (10 kg gain). To our knowledge, this is the first reported occurrence of a sporadic, and third overall occurrence, of a hemangioblastoma that presented with an anorexia nervosa-like syndrome that was ultimately cured with surgical resection. In patients presenting with a history of psychiatric illness, it is important to consider the possibility of underlying, organic pathologies in the central nervous system affecting the relevant neuro-anatomical domains.
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Affiliation(s)
- Isaac J Abecassis
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Silvani A, Gaviani P, Lamperti E, Botturi A, Ferrari D, Simonetti G, Salmaggi A. Malignant gliomas: early diagnosis and clinical aspects. Neurol Sci 2012; 32 Suppl 2:S207-8. [PMID: 21993829 DOI: 10.1007/s10072-011-0788-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brain tumor symptoms vary greatly from person to person because of two factors: location and size of tumors. The size of a tumor, however, does not necessarily affect the severity of symptoms. Manifestations depend on the cause of the symptoms: an increase in ICP, direct compression of gray or white matter, shifting of intracranial contents, or secondary cerebral ischemia. Symptoms may be non-specific and include headache, altered mental status, ataxia, nausea, vomiting, weakness, and gait disturbance. Left-sided weakness may be seen in a patient with a tumor pressing on the contra-lateral motor strip or speech difficulties may occur if a tumor is in the dominant hemisphere. Up to a third of people report having seizures prior to being diagnosed with a brain tumor. Rarely, brain tumor can present with psychiatric symptoms but without other neurological signs or symptoms. Evaluation for brain tumor is indicated in any patient with chronic, persistent headache associated with protracted nausea, vomiting, seizures, changes in headache pattern, neurologic symptoms, and change in personality.
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Affiliation(s)
- A Silvani
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy.
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Schleim S. Brains in context in the neurolaw debate: the examples of free will and "dangerous" brains. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2012; 35:104-111. [PMID: 22289293 DOI: 10.1016/j.ijlp.2012.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Will neuroscience revolutionize forensic practice and our legal institutions? In the debate about the legal implications of brain research, free will and the neural bases of antisocial or criminal behavior are of central importance. By analyzing frequently quoted examples for the unconscious determinants of behavior and antisocial personality changes caused by brain lesions in a wider psychological and social context, the paper argues for a cautious middle position: Evidence for an impending normative "neuro-revolution" is scarce and neuroscience may instead gradually improve legal practice in the long run, particularly where normative questions directly pertain to brain-related questions. In the conclusion the paper raises concerns that applying neuroscience methods about an individual's responsibility or dangerousness is premature at the present time and carries serious individual and societal risks. Putting findings from brain research in wider contexts renders them empirically investigable in a way that does not neglect psychological and social aspects of human mind and behavior.
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Affiliation(s)
- Stephan Schleim
- Theory and History of Psychology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
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Owecki MK, Michalak S, Kozubski W. [Psychopathological syndromes of neurological diseases in the elderly]. Neurol Neurochir Pol 2011; 45:161-8. [PMID: 21574121 DOI: 10.1016/s0028-3843(14)60028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular and degenerative diseases of the central nervous system are one of the most common health problems in the elderly. Cognitive dysfunction, mood disorders and behavioural changes as well as psychotic symptoms constitute an invariable part of the clinical manifestation of these diseases. Psychopathological syndromes influence management decisions, commonly being a reason for patients' institutionalization; they are also a cause of suffering of patients and their caregivers and relatives. Relevant diagnosis of psychological symptoms is crucial in establishing adequate therapy, which improves quality of life of patients and their caregivers. The paper provides an overview of the psychopathological presentation of the most common central nervous system diseases in the elderly.
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Affiliation(s)
- Michał K Owecki
- Klinika Neurologii UM w Poznaniu, ul. Przybyszewskiego 49, 60-355 Poznań.
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