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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuropsychiatric problems, and how they interact to impact on quality of life (QOL) in brain tumor patients, are generally poorly understood. The objectives of this study were: (1) to document the prevalence of depression, fatigue, emotional distress, and existential issues in a sample of brain tumor patients (2) to examine the interconnectedness of these problems, and (3) to explore their relationship with disease-related variables and QOL. This is a cross-sectional, questionnaire-based survey of 73 patients with primary brain tumors who presented to a neurological clinic at a tertiary cancer centre for ongoing care. Data for 60 participants (29 women, 31 men) who completed validated questionnaires were retained for analysis. Results showed that there was a high burden of depressive symptoms as measured by the Beck Depression Inventory-II (mean score 11.1, SD 7.4), with 38% of the sample scoring in the clinically depressed range. Overall QOL scores for this sample were similar to a reference sample of brain tumor patients. The scores on the existential subscale of the McGill Quality of Life questionnaire were comparable to those of a reference sample of cancer patients receiving ongoing care (mean score 7.2; SD 1.7). Fifty per cent of the sample could be classified as struggling with existential issues. Although scores reflecting depression, fatigue, emotional distress, and existential problems were interrelated, the presence of depressive symptoms was the single most important independent predictor of QOL in this cohort of brain fumor patients. Implications for treatment are discussed.
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PMID:Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. 1212 66

The Wechsler Memory Scale-Revised (WMS-R) malingering indices proposed by Mittenberg, Azrin, Millsaps, and Heilbronner [Psychol Assess 5 (1993) 34.] were partially cross-validated in a sample of 200 nonlitigants. Nine diagnostic categories were examined, including participants with traumatic brain injury (TBI), brain tumor, stroke/vascular, senile dementia of the Alzheimer's type (SDAT), epilepsy, depression/anxiety, medical problems, and no diagnosis. Results showed that the discriminant function using WMS-R subtests misclassified only 6.5% of the sample as malingering, with significantly higher misclassification rates of SDAT and stroke/vascular groups. The General Memory Index-Attention/Concentration Index (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering when a difference score of greater than 25 points was used as the cutoff criterion. No diagnostic group was significantly more likely to be misclassified. Results support the utility of the GMI-ACI difference score, as well as the WMS-R subtest discriminant function score, in detecting malingering.
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PMID:Partial cross-validation of the Wechsler Memory Scale-Revised (WMS-R) General Memory-Attention/Concentration Malingering Index in a nonlitigating sample. 1459 79

Glioblastoma multiforme is the most malignant astrocytic neoplasm and the most common brain neoplasm of humans. Spontaneous neoplasms of the brain are rare in nonhuman primates. This report describes three glioblastomas in adult captive-reared baboons. The animals exhibited a range of clinical signs, including depression, weight loss, weakness, and blindness. All three neoplasms were located in the cerebrum, with extension into the pons in one case. Histologically, the tumors were similar and were characterized by cellular pleomorphism, multinucleated cells, areas of necrosis, microvascular proliferation (glomeruloid bodies), and palisading of neoplastic cells around blood vessels and areas of necrosis. Two baboons exhibited gemistocytic differentiation, and in one baboon, the neoplastic cells were predominantly spindle shaped with a fascicular growth pattern. Immunohistochemical staining for glial fibrillary acidic protein, vimentin, and S-100 protein was positive, whereas immunostaining for synaptophysin and chromogranin A was negative. Positive staining for the cell proliferation marker Ki67 ranged from 8.2% to 13.9%. Terminal deoxynucleotidyl transferase mediated dVTPnick end labeling (TUNEL) staining ranged from 1.8% to 5.7%. These baboon glioblastomas share many features with those of humans.
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PMID:Glioblastoma multiforme in three baboons (Papio spp). 1523 46

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.
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PMID:Brain tumor and psychiatric manifestations: a case report and brief review. 1532 4

Patients with primary brain tumors and those with cerebral metastases are at risk throughout their illness for several major medical problems, including vasogenic edema, seizures, and symptomatic venous thrombosis. In turn, the corticosteroids, anti-epileptic drugs, and anticoagulants used to treat these problems may produce significant adverse effects and result in important drug-drug interactions that may complicate chemotherapy. Although few Class I studies address any of these issues, guidelines can be offered to maximize quality of life and minimize hospital readmissions. Optimal management of brain edema involves minimizing corticosteroid use and tapering the steroid dose slowly to avoid steroid withdrawal symptoms. Prophylaxis of Pneumocystis pneumonia is necessary for patients requiring corticosteroids for more than 1 month. Anti-epileptic drugs (AEDs) should be avoided unless patients experience seizures. If possible, non-CTY (P450) enzyme-inducing drugs should be chosen. AED levels should be obtained frequently during corticosteroid taper. Multimodality venous thrombosis prophylaxis should begin at the time of the original surgery with external leg compression and unfractionated subcutaneous heparin or a low molecular weight heparin (LMWH). Brain tumor patients with symptomatic venous thrombosis or pulmonary embolism can be anticoagulated safely with warfarin or with LMWH, and LMWHs are preferable from the standpoints of efficacy, safety, and convenience for long-term outpatient treatment of venous thrombosis. Clinicians should be aware of potential drug-drug interactions between prescribed AEDs and chemotherapy and possible interactions with complementary and alternative therapies chosen by their patients. They also should be aware of interventions to minimize late sequelae of brain tumors and their treatment, including cognitive decline, depression, and increased stroke risk.
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PMID:Treatment of Medical Complications in Patients with Brain Tumors. 1596 95

Malignant brain tumors and the therapies used to treat them can present challenging problems. Headache is the most common symptom during brain tumor illness. Etiology determines the exact management approach, but pharmacologic and non pharmacologic measures may be used. Seizures also commonly occur and are best managed with anti epileptic drug therapy. Infection and deep venous thrombosis are concerns and are best approached by preventive measures and early aggressive intervention if those measures fail. Depression, fatigue, memory and personality changes may complicate care and are approached on an individual basis. Early discussion about end-of-life issues is necessary because the disease itself can impair decision-making ability.
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PMID:Managing symptoms and side effects during brain tumor illness. 1627 64

Patients in psychiatric settings may present with medical conditions, such as brain tumors, which may or may not be associated with neurological symptoms. In some cases, patients may only have psychiatric symptoms, such as mood changes (depression or mania), psychotic symptoms, panic attacks, changes in personality, or memory difficulties. Brain tumors may be detected in patients at their first presentation to mental health services or sometimes in patients with well-established psychiatric diagnoses. This article presents the case of a 29-year-old woman who was treated for >4 years for posttraumatic stress disorder and borderline personality traits, who developed depressive symptoms and memory difficulties. However, she did not develop any major neurological signs or symptoms. Brain imaging showed the presence of a left thalamic tumor, later confirmed as glioblastoma multiforme. She underwent surgical treatment and radiation therapy. With this we show that in some cases, brain tumors can be neurologically silent and only present atypical psychiatric symptoms. We emphasize the need for neuroimaging studies in a patient with atypical changes in mental status, even without neurological signs or symptoms.
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PMID:Psychiatric symptoms associated with brain tumors: a clinical enigma. 1640 Feb 53

The presenting signs of a mature, spayed female, domestic shorthair cat with a thalamic astrocytoma were polyuria, polydipsia and behavioral changes of several months duration, followed by pacing and depression. Dexamethasone therapy temporarily improved the cat's mental status. A diagnosis of brain tumor was confirmed by postmortem examination.
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PMID:Astrocytoma in a cat. 1742 60

A symptom cluster comprises three or more concurrent symptoms. There is a paucity of symptom cluster research in cancer patients. Data from a previously conducted clinical trial were analyzed to search for symptom clusters. This phase III, placebo-controlled, double-blind, prospective, randomized clinical trial of 66 patients assessed the effect of prophylactic d-threo-methylphenidate (d-MPH) on quality of life (QOL) in newly diagnosed brain tumor patients receiving brain radiation therapy. Patients received 5-15 mg of d-MPH or placebo twice daily starting on week 1 of radiation therapy and continuing for 8 weeks post radiotherapy. QOL data were collected at baseline; the end of radiation therapy; and 4, 8, and 12 weeks following radiation therapy using the Functional Assessment of Cancer Therapy (FACT), the FACT-Brain subscale, and the Center for Epidemiologic Studies Depression Scale. Exploratory factor analysis, multidimensional scaling (MDS), and cluster analysis were used to search for symptom clusters. The trial failed to show a treatment effect; patients receiving d-MPH or placebo were analyzed together to search for clusters. Two symptom clusters were identified using exploratory factor analysis--a language cluster including difficulty reading, writing, and finding the right words and a mood cluster including feelings of sadness, anxiety, and depressed mood; these clusters were supported by MDS and cluster analysis. Our results suggest that interventions that target both cognitive function and mood should be considered in this patient population. Further research on symptom clusters in brain tumor patients is needed.
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PMID:Symptom clusters in patients with newly-diagnosed brain tumors. 1801 50

To determine clinical and sociodemographic factors that are associated with major neuropsychiatric illnesses among brain tumor patients, we administered a modified version of the Brief Patient Health Questionnaire and a demographic data form to 363 adult neuro-oncology patients. Responses were analyzed to assess for associations between demographic variables, clinical variables, and symptoms consistent with diagnoses of generalized anxiety disorder and/or depression. Multivariate logistic regression analyses showed that female gender was associated with the presence of symptoms of anxiety, depression, and combined anxiety and depression. Lower WHO tumor grade classifications, lower education level, and a history of psychiatric illness also emerged as important predictors of symptoms consistent with anxiety and/or depression. Marital status and presence of past/current medical illness trended toward being significantly associated with depression alone. Patient use of psychiatric medication was not associated with any study variables. Results of the present study suggest several hypotheses to test with neuro-oncology patients in further longitudinal analyses, which would benefit from the inclusion of a wider range of neuropsychiatric symptoms in conjunction with neurocognitive and functional impairment variables.
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PMID:Evaluation and characterization of generalized anxiety and depression in patients with primary brain tumors. 1831 16


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