Psychiatric aspects of brain tumors: A review

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.     

Psychiatric aspects of Wilson disease: a review

Objective

To review the current evidence about psychiatric symptoms in Wilson's disease (WD).

Method

We searched Ovid, PsychInfo, CINHAL and PubMed databases from May 1946 to May 2012 using the key words Wilson('s) disease in combination with psychiatry, psychiatric, psychosis, schizophrenia, depression, mania, bipolar, mood, anxiety, personality and behavior.

Results

Psychiatric symptoms occur before, concurrent with or after the diagnosis and treatment for WD. Thirty to forty percent of patients have psychiatric manifestations at the time of diagnosis, and 20% had seen a psychiatrist prior to their WD diagnosis. When psychiatric symptoms preceded neurological or hepatic involvement, the average time between the psychiatric symptoms and the diagnosis of WD was 864.3 days. The prevalence of psychiatric disorders in WD patients varies wildly (major depressive disorder, 4–47%; psychosis, 1.4–11.3%). Certain gene mutations of ATP7B may correlate with specific personality traits.

Conclusions

Psychiatric manifestations represent a significant part of the clinical presentation of WD and can present at any point in the course of the illness. Psychiatric manifestations occurring without overt hepatic or neurologic involvement may lead to misdiagnosis. A better understanding of the psychiatric presentations in WD may provide insights into the underlying mechanisms of psychiatric disorders.     

Psychiatric aspects of oncology: a review of recent research

Psychiatrists diagnose and treat the mental disorders of cancer patients, but they are also concerned with pain management, the patient's adaptation to the disease, and the attitudes of relatives and health care professionals toward the cancer patient. The author reviews recent research on these areas of concern and discusses the psychiatric complications of cancer such as organic brain syndromes, depression, and anxiety; the pharmacotherapy of such complications; and the role of psychological factors in the etiology of cancer. Approaches to informing patients of their cancer diagnosis and other implications for clinical practice are also covered.     

Psychiatric aspects of pain

PURPOSE OF REVIEW: Pain is a common reason for seeking healthcare. Chronic pain is commonly comorbid with psychiatric disorders. New evidence provides fresh insights into the nature of the link between pain and mental disorders and offers opportunity to refine treatment approaches. RECENT FINDINGS: Even though depression is the most commonly studied comorbid psychiatric disorder, new studies show that other mental disorder, especially anxiety disorders, are also common. Comorbid conditions, including other chronic physical conditions, account for a substantial proportion of the disability associated with chronic pain conditions. The causal link between chronic pain and mental disorders may vary depending on the specific mental disorder, but the link may be mediated by biological, psychological, and social factors. Recent findings also suggest that the evolution of the comorbidity may differ between the sexes. Promising interventions for chronic pain that also target contextual psychosocial problems have been recently described. SUMMARY: The frequent occurrence of mental disorders among patients with pain, especially those whose pain is chronic, has implications for the management of such patients. Current understanding of the complexity of this link not only provides opportunities for designing appropriate interventions but also raises new questions for further research.     

Psychiatric aspects of religiousness

Psychiatric aspects of religiousness have been a rather neglected research area in the near past despite the paradigm change in the religiousness research. This change is manifested in the increase of the number of research studies as well as the great development of research methodology. In this review the authors explore the most important cross points of religiousness and psychiatry with data on mental and physical health, substance use, dimensional characteristics of religiousness, and related factors as well.     

Psychiatric aspects of AIDS

Acquired immune deficiency syndrome (AIDS) has neuropsychiatric and psychopathological complications: anxiety, depressive symptoms, and suicidal ideation are common. Patients may express anger toward ineffective medical care and perceived public discrimination, guilt about sexual practices or drug abuse, reactions to social isolation, and uncertainty about the implications of an AIDS diagnosis. CNS dysfunction and subsequent neuropsychiatric impairment are common and are initially characterized by decreased acuity, slowed mentation, and psychomotor retardation that can resemble depression. Marked global cognitive deficits, disorientation, and delusions ensue. The author discusses case management and outlines future clinical and research activities.     

Psychiatric aspects of homicide

Homicide is frequently associated with mental illness and suicide. The present study is an investigation of all known homicide incidents in Iceland during the past 80 years (1900–1979). There were 45 homicide incidents, involving 52 victims and 47 offenders. One-third of the perpetrators were either psychotic, mentally subnormal, or committed suicide. A further one-third were diagnosed as personality disordered, alcoholic, drug dependent or neurotic. A substantial proportion of the offenders suffered from fairly marked physical disabilities, and the mentally ill were significantly more frequently afflicted by such defects. Over 60 % of the offenders and 50 % of the victims were under the influence of alcohol at the material time. The findings are generally consistent with those of previous psychiatric studies of homicide.     

Psychiatric aspects of Epilepsy

The classification of epileptic seizures is reviewed, emphasizing the clinical features of partial seizures with psychic symptoms. Psychiatric issues in epilepsy are also assessed, particularly affective disorders and psychosis. Although there currently is no internationally accepted syndromic classification for them, we expose recently proposed definitions. The concept of "epileptic personality" is reviewed, and the matter of aggression as well. Finally we include a case report that illustrates what we understand as the complexity for the clinical diagnosis.     

Psychiatric aspects of radiotherapy

The authors evaluated 200 cancer patients, half of whom received betatron therapy and half linear accelerator therapy. The incidence and severity of anxiety and depression were high in both groups; as radiotherapy continued these symptoms tended to decrease in intensity among the patients treated with the linear accelerator and to increase among the betatron patients. Patients who denied knowledge of their diagnosis were initially less depressed and remained less depressed than those who knew or suspected that they had cancer.     

Psychiatric aspects of bone marrow transplantation: a review and current issues

BMT represents a major medical advance and offers to most individuals who undergo this procedure the only hope for long term survival. The current psychiatric literature is anecdotal and mostly restricted to discussion of psychiatric issues related to the BMT hospitalization itself. There is substantial agreement about the important psychiatric issues concerning BMT recipients, their families, and the BMT team. However, many post-BMT hospitalization psychiatric and psychosocial issues need attention: the psychological impact of being a BM donor, the consequences of BMT for donor-recipient relationships, the long-term family consequences of BMT, and the long-term cognitive, neuroendocrine, sexual/reproductive, and psychosocial status of BMT survivors. Hopefully, these issues will be increasingly rigorously and effectively addressed in the near future, so that effective psychiatric and psychosocial interventions can be developed which maximize the psychosocial outcome of those affected by BMT.     

Psychiatric aspects of mercury poisoning

Mercury poisoning (although relatively rare) is still a concern for the psychiatrists. Neuropsychiatric manifestations include irritability, emotionational instability and an asthenic vegetative syndrome (erethism). With specific laboratory tests becoming more available and chelation becoming easier to accomplish, this entity should be considered in selected patients.     

Psychiatric aspects of late-life insomnia

Epidemiological trends towards a 'graying' population make the issue of insomnia in the elderly an increasingly important research and clinical topic. It is often challenging to determine how much of a psychiatric dimension there is to a clinical condition that is best viewed as both as a symptom and a true psychosomatic entity in its own right. To categorize insomnia as either psychiatric or medically based risks oversimplification of the complexities of sleep disruption in the elderly. Normal senescence-related changes in sleep architecture and circadian rhythms must be considered, as well as the frequent medical comorbidities that may affect sleep. Psychiatric diagnoses to consider include mood and anxiety disorders, which may be affected equally by physiological and psychological changes implicit in old age. Sleep disruption related to dementia is of particular interest to clinicians involved with patients in long-term care facilities. Insomnia may occasionally be iatrogenically induced or exacerbated, and particularly antidepressants must be carefully selected for this reason. Light therapy and behavior therapies are important in multimodal treatment of insomnia, and sleep hygiene includes both regular physical and social activities to preserve entrainment of circadian rhythms affecting sleep.     

Psychiatric aspects of organ transplantation

Technical advances in surgery and the new antirejection agents cyclosporine and muromonab-CD3 have led to improved outcome for organ transplantation. Allograft rejection and complications of immunosuppressant therapy are often associated with considerable stress, so availability of psychiatric consultation is a necessity. As a transplant team consultant, the psychiatrist treats perioperative anxiety, depression, and organic brain dysfunction and addresses medical and ethical aspects of patient selection. Studies indicate that many patients with psychopathological conditions have good postoperative results and that most living kidney donors participate spontaneously and consider donation a positive experience.     

Psychiatric aspects of high-risk pregnancy

The intensity and ramifications of emotional reactions to high-risk pregnancy make liaison work in this field interesting, challenging, and rewarding. The potential benefits include not only improved obstetric patient care, but also risk reduction in the mother-child relationship that follows.