3.3 BRAIN TUMORS
Tumors involving the central nervous
system (CNS) are common. It has been reported that primary brain tumors
are upto 10 times more common among psychiatric patients than in
psychiatrically health control subjects and that mental changes and
behavioral symptoms, including confusion and various other
neuropsychiatric symptoms are more frequent early indicators of primary
brain tumors than are classic physical manifestations such as headaches,
seizures, and focal neurological signs (Kocher et al., 1984). The presence
of one or more of the following signs and symptoms in a psychiatric
patient should heighten the clinician’s index of suspicion regarding the
possibility of a brain tumor: (1) Seizures, especially of new onset in an
adult and if they are partial seizures (2) Headaches, especially if of new
onset; generalised and dull; of increasing severity and/or frequency; or
positional, nocturnal, or present immediately on awakening (3) Nausea and
vomiting, especially in conjunction with headaches (4) Sensory changes (5)
Other focal neurologic signs and symptoms (Price et al., 2002).
Presence and the nature of
neuropsychiatric symptoms is influenced by many factors, including the
extent of tumor involvement, the rapidity of its growth, its propensity to
cause increased intracranial pressure, the patient’s premorbid psychiatric
history, level of functioning, and characteristic psychological coping
mechanisms (Price et al., 2002). Mental changes are likely to occur in
patients with supratentorial tumors, and more commonly among patients with
tumors of the frontal and temporal lobes (Keschner et al., 1938).
Depression is reported to be more common in frontal lobe tumors and
psychosis in temporal lobe tumors (Filley and Kleinschmidt-DeMasters,
1995). Left sided frontal tumors are more commonly associated with
akinesia and depression, while right sided lesions are more often
associated with euphoria (Belyi, 1987).
The psychopharmacologic treatment of organic syndromes
caused by brain tumors follows the same general principles as the drug
treatment of phenomenologically similar symptoms due to primary
psychiatric illnesses. However, the side-effect profiles of the
psychotropic drugs being considered need to be very carefully evaluated,
especially with regard to sedative, extrapyramidal, deliriogenic and
epileptogenic effects, as well and the potential for drug interactions
(Price et al., 2002). |
