Evaluation of comorbid psychiatric disorders in patients with primary brain tumors before and after surgery (original) (raw)
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Study of Association of Various Psychiatric Disorders in Brain Tumors
Asian journal of neurosurgery, 2022
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.
Depression and Anxiety Disorders in a Sample of Saudi Persons with Brain Tumor
Global Journal of Health Science
BACKGROUND: Depression and anxiety (DA) are common in persons with brain tumor (PBT) and are associated with neurocognitive deficits. The terms DA and affective disorders are often used interchangeably in this study. Objective: This was a pilot study, conducted with the purpose of better assessing DA symptoms in association with socioeconomic and clinical characteristics in PBT. METHOD: A cross-sectional study was conducted on a sample of PBT (N = 102), recruited from a neurosurgical department. The tools employed were the Beck Depression Inventory-II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS). The self-rating instruments proved feasible and reliable in screening for the severity of DA symptoms. The HADS is designed to measure the severity of anxiety and depressive symptoms in non-psychiatric hospital outpatients and does not assess the common somatic symptoms of these two disorders. The BDI-II evaluates the severity of depressive symptoms with items related to ph...
Predicting major depression in brain tumor patients
Psycho-Oncology, 2002
Very few studies have been performed utilizing DSM criteria to diagnose major depressive disorder (MDD) in adult brain tumor patients. This study aimed to diagnose MDD in this population using DSM-IV criteria. Eighty-nine adult brain tumor patients were examined in an ambulatory neuro-oncology clinic setting using a structured psychiatric interview which followed current DSM-IV diagnostic criteria for MDD. This sample was interviewed and evaluated on a one-time basis. The patients were referred for evaluation on a consecutive basis. Multiple regression was used to model critical independent variables to predict MDD. Twenty-eight percent of the sample (N ¼ 89) were found to have major depressive disorder using DSM-IV criteria. Key predictors of MDD included frontal region of tumor location (p ¼ 0:001), combined sadness and lack of motivation symptoms (p ¼ 0:0001), and family psychiatric history (p ¼ 0:006). The multiple regression models account for 37% of variance in predicting MDD (R 2 ¼ 0:37). A substantially higher incidence of MDD was found in this sample of adult brain tumor patients compared with other adult, ambulatory cancer patients previously evaluated with DSM criteria. The incidence of MDD was about triple that found in other published studies using DSM criteria.
Association of preoperative depression and survival after resection of malignant brain astrocytoma
Surgical Neurology, 2009
Background: Clinical depression has been shown to negatively influence the morbidity and mortality of multiple disease states. It remains unclear if clinical depression affects survival after surgical management of malignant brain astrocytoma. We set out to determine whether patients with a diagnosis of clinical depression before surgery experienced decreased survival independent of treatment modality or degree of disability. Methods: One thousand fifty-two patients undergoing surgical management for malignant brain astrocytoma (WHO grade 3 or 4) performed at a single institution from 1995 to 2006 were retrospectively reviewed. The independent association of depression prior to surgery and subsequent survival was assessed via multivariate proportional hazards regression analysis. Results: Surgical management consisted of primary resection in 605 (58%) patients, secondary resection in 410 (39%), and biopsy in 37 patients (3.5%). Pathology was WHO grade IV in 829 (79%) and grade III in 223 (21%). Forty-nine patients (5%) carried the diagnosis of depression at the time of surgery. Mean age and KPS on admission was 51 ± 16 and 80 ± 10 years, respectively. Two hundred ninety patients (28%) received Gliadel (BCNU MGI Pharma, Inc., Bloomington, MN, USA) wafer implantation and 274 (26%) received postoperative temozolomide (concomitant in 102, delayed adjuvant in 172 patients). Subsequent resection was performed at the time of recurrence in 135 (13%) patients a mean of 10 ± 6 months after surgery. Adjusting for all variables associated with survival in this model, age (P b .001), KPS (P b .001), WHO grade III vs IV (P b .001), primary versus secondary resection (P b .001), grosstotal resection (P b .001), Gliadel wafer implantation (P = .048), postoperative temozolomide therapy (P b .001), and subsequent resection at time of recurrence (P b .001); preoperative depression was independently associated with decreased survival (relative risk [95% CI]: 1.41 [1.1-1.96], P b .05). The difference in percent survival between the depression and nondepression cohorts was most notable at 12 months (15% vs 41%) and 20 months (0% vs 21%) after surgery. Conclusion: In our experience, patients who are actively depressed at the time of surgery were associated with decreased survival after surgical management of malignant astrocytoma, independent of degree of disability, tumor grade, or subsequent treatment modalities. In our opinion, the presence of an association between preoperative depression and survival warrants further investigation.
Journal of Clinical …, 2002
Few studies have examined quality of life issues in patients with brain tumors, though coping with cancer is stressful and is associated with heightened levels of depression. We used regression to examine the clinical factors that might predict depression in a group of 57 adults with low-grade brain tumors after surgery but prior to radiotherapy and chemotherapy. A neurological model comprised of tumor characteristics and treatment was compared with a psychogenic model comprised of both psychosocial and psychodynamic variables. Demographic variables and level of fatigue were also included. A model consisting primarily of fatigue (also clinically elevated) and secondarily of tumor location and aggressiveness of surgical treatment accounted for 33% of the depression score. In a small group at a later follow-up when patient depression was clinically elevated (4-6 years after baseline), fatigue, female sex, cognitive dysfunction, increased family support, and increased report of physical symptoms were associated with depression. The late out findings remain exploratory because of the small sample size, but they suggest that depression develops over time and results from a combination of neurological and psychosocial problems that ensue initial treatments. Treating these collateral problems may reduce the complications from depression.
Psychiatric Manifestations as the Primary Presentation of Frontal Meningioma
The Ochsner journal, 2023
Background: Although some patients with primary brain lesions remain clinically asymptomatic, others may experience a range of symptoms, including headaches, seizures, focal neurological deficits, changes in baseline mental function, and psychiatric manifestations. Distinguishing between a primary psychiatric illness and symptoms of a primary central nervous system tumor can be especially difficult for patients with a history of mental illness. A major challenge in effectively treating patients with brain tumors is first obtaining the diagnosis. Case Report: A 61-year-old female with a medical history significant for bipolar 1 disorder with psychotic features, generalized anxiety, and previous psychiatric hospitalization presented to the emergency department with worsening depressive symptoms and without focal neurologic deficits. She was initially placed on a physician's emergency certificate for grave disability, with anticipated discharge to a local inpatient psychiatric facility once she was stabilized. A frontal brain lesion, concerning for a meningioma, was found on magnetic resonance imaging and she was instead transferred to a tertiary center for urgent neurosurgical consultation. Bifrontal craniotomy with neoplasm excision was performed. The patient's postoperative course was uneventful, and continued symptom improvement was noted at the patient's 6-and 12-week postoperative visits. Conclusion: This patient's clinical course exemplifies the clinical ambiguity associated with brain tumors, the challenge of obtaining a timely diagnosis with nonspecific symptoms, and the importance of neuroimaging for patients presenting with atypical cognitive symptoms. This case report contributes to the literature about the psychiatric manifestations of brain lesions, especially in patients with concurrent mental health disorders.
Impact of Anxiety and Depression on Quality of Life in Elderly Patients with Brain Tumor
International Journal of Indian Psychology, 2023
Background: Psychological health plays a crucial role in the well-being and quality of life. Diagnosis of brain tumor and subsequent surgery can have a significant impact on a patient's well-being especially with the natural course of ageing. The uncertainty of the diagnosis, the potential impact on daily functioning, after effects of the surgery can all contribute to psychological distress, including anxiety and depression in an elderly person. The aim of the present study is to find the influence of depression and anxiety on the quality of life of elderly people who underwent brain tumor resection. Method: Using descriptive research design a sample of 50 post operative patients between age group 55-75 were selected. The Malayalam version of HADS and WHOQOL-BREF were administered along with exploring other sociodemographic variables. Results: Correlational analysis, ANOVA and post hoc tests were employed. The results showed that high anxiety levels were associated with a lower QoL (p = .006). However, depression levels did not have a significant impact on QoL. Additionally, there was a positive correlation between general health and QoL score (r = 0.685, p < .001), indicating that better general health was associated with a better QoL. Conclusion: Study suggest that psychological and physical factors should be considered when assessing and treating the elderly people who underwent brain tumor resection. The results might help the rehabilitation professionals, doctors as well the caregivers of post operative patients to understand their psychological well-being and adapt appropriate measures to support them for speedy recovery as well.
Emotional and social dysfunction in patients following surgical treatment for brain tumour
Journal of Clinical Neuroscience, 2003
Patients following brain surgery for tumour were assessed using the Emotional and Social Dysfunction questionnaire on a self-rating and partner version of the questionnaire. Analyses were performed on those patients who had self-ratings following surgery for astrocytoma (n ¼ 13), meningioma (n ¼ 26), neuroma (n ¼ 13) and pituitary adenoma (n ¼ 17). Patients with astrocytoma were rated highest when compared to the other tumour groups, although all groups of patients performed more poorly on some of the individual scales compared to a matched control group of extra-cerebral neurosurgery patients and terminally ill cancer patients. A malignant (n ¼ 48) and benign (n ¼ 33) classification similarly showed a higher partner and self-rating of malignant tumour patients. Both diagnosis and location of lesion determined outcome independently. Some differences in profile and severity between patient self-ratings and partner ratings indicate the need to survey both perspectives. This study shows a broader based emotional dysfunction in these patients which includes such prominent features such as anger, helplessness, fatigue, emotional dyscontrol, indifference, and maladaptive behaviour. These results are discussed in terms of follow-up therapeutic care and the need to further explore the relationship between lesion location and emotional profile. ª
Brain Tumor and Psychiatric Manifestations: A Case Report and Brief Review
Annals of Clinical Psychiatry, 2004
Brain tumors may present multiple psychiatric symptoms such as depression, personality change, abulia, auditory and visual hallucinations, mania, panic attacks, or amnesia. A case of a 79-year-old woman who presented with depressive symptoms but showed minimal neurological signs and symptoms is discussed. Neuroimaging revealed a brain tumor in the left parietal lobe, and patient underwent neurosurgical treatment and subsequently received chemotherapy and radiation. Some patients with neurologically silent brain tumors may present with psychiatric symptoms only. Therefore, we emphasize the consideration of neuroimaging in patients with a change in mental status regardless of a lack of neurological symptoms.