Sunday, July 1, 2012

Study: Psychiatrists Must Test for Tumors Even When No Signs

Pennsylvania residents under the care of licensed psychiatrist will want to read an interesting article published in the Journal of Primary Psychiatry a couple of years ago. The report titled Brain Lesions Manifesting as Psychiatric Disorders: Eight cases, discusses eight patients in treatment for various psychiatric conditions.  Despite the patients' lack of neurological deficits each one was eventually diagnosed with a brain tumor.  It is believed that the patients' brain tumors may have played a significant role in their psychiatric presentation.  The report points out however, that the results were less than perfect as there was little clinical follow up how the patients' psychiatric conditions were affected post-surgical removal of the brain tumors.

There were some interesting statistics referenced in this study.  For instance, 1/1,000 of hospitalized psychiatric patients have brain tumors. What is surprising about that figure is that it represents an isntance of brain tumor ~20-times higher than in our general population. Furthermore, it has been found that 21% of patients with benign meningiomas presented with psychiatric symptoms, such as depression, anxiety disorders, or personality changes, in the absence of neurologic signs.  And it is that last part that patients in Pittsburgh, and across the state will want to be particularly aware of.  Brain tumors are known to cause psychiatric symptoms in the absence of overt neurological symptoms.

This is an important issue because it broadens the range of conditions licensed psychiatrists must consider when diagnosing their patients' conditions.  Even in the absence of overt neurological symptoms, psychiatrists must always be suspicious of a possible neurologic cause of the psychiatric pathology.  In many instances, thsi requires the psychiatrist to not only do a full physical evaluation of the patient but, more often than was done in the past, send the patient for neurodiagnostic imaging.  And this just gets back to the primary rule of differential diagnosis that a doctor cannot take a dangerous condition off the list of possible diagnoses until it has been fully ruled out.

The take aways from this study are as follows: 

• Patients with organic brain lesions might present with a variety of psychiatric symptoms for a sufficient period of time in the absence of neurologic symptoms and signs.

• Delay to perform brain imaging might have a direct negative effect on treatment options and quality of life of such patients.

• Brain imaging should be considered not only for psychiatric patients with neurologic symptoms and signs, but for all psychiatric patients who present with atypical psychiatric symptoms, with late onset of psychiatric symptoms (>50 years of age), or there is a change in clinical presentation of psychiatric symptoms.

If you or someone you care about is currently under psychiatric treatment, it cannot hurt to keep the suggestions of this study in mind.

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