P01.099 Psychiatric alterations and behavioural changes in brain tumor patients. (19th September 2018)

• Record Type: Journal Article
• Authors: Grisold, A; Guekht, A; Ruda, R; Grisold, S; Grisold, W
• Is Part Of: Neuro-oncology. Volume 20(2018)Supplement 3
• Page Start: iii253
• Page End: iii254
• Publication Date: 2018-09-19
• Subjects: Brain Neoplasms -- Periodicals; Brain -- Tumors -- Periodicals; Brain -- Cancer -- Periodicals; Nervous system -- Cancer -- Periodicals; 616.99481
• DOI: 10.1093/neuonc/noy139.141
• Languages: English
• ISSNs: 1522-8517

Abstract

Abstract: Background: Managing patients with brain tumors can involve behavioral and psychiatric phenomena, occurring at different time points. Methods: Review of the literature. Results: Five causes were identified. 1. Focal and diffuse brain damage by the tumor Symptoms of anger, loss of emotional control, indifference and changes in behavior and personality appear. The extent to which tumor location impacts on psychopathology is not clear. Clinically, also apathy and loss of executive function can occur. In lesions of the paralimbic structures mood swings are dominant. Neuropsychological symptoms are related to focal pathology. 2. Psychiatric causes Manifestations can present as anxiety, depression, mania and psychosis. Few recent publications are available. It is useful to make a distinction between a, , psychiatric reaction (towards the disease)" and an organic psychosis. 3. Influence of seizures on behavior Brain tumors are one of the main causes of acquired epilepsies and are associated with 3–6% of all new cases of epilepsy. Rapidly growing tumors, as glioblastomas (GBM), are frequently associated with seizures. In patients with primary brain tumors with epilepsy cognitive impairment, abnormal scores in the anxiety scale and depression were noted. Brain tumors can cause status epilepticus, including the non-convulsive type. 4. Tumor treatment Treatment-induced effects may occur at any stage of the disease. Radiation can induce acute, or delayed effects, which are important in low grade glioma (LGG), and less frequent in GBM. Steroids can have psychotropic effects, ranging from unspecific excitatory state, towards psychosis and depression. Also, rapid discontinuation of prolonged steroid therapy causes mood swings. The issue of "chemobrain" has been attracting attention in the treatment of LGG. The clinical correlation is slowing of mentation and cognition and is also termed, , chemofog". Most antineoplastic drugs used for the treatment of GBM, as temozolomide (TMZ) do not have psychotropic effects. Older drugs as procarbazine can cause psychiatric symptoms. VEGF inhibitors, can induce "posterior reversible encephalopathy syndrome" resulting in mental changes. Benzodiazepines, antidepressants and rarely anti-dementia drugs can cumulate and cause delirium as well as anticonvulsants. 5. Overlap of several causes Practically, often several causes can overlap. The identification of the most prevalent cause is important, followed by symptomatic therapy. Conclusion: Psychiatric alterations can be part of the management of patients with brain tumors. Symptom-oriented treatment of psychiatric manifestations, including psychotherapy, drug treatment and individual care is warranted. Communication with patients, caregivers and the involved health care professionals is essential.