Distinguishing and treating depression, anxiety, adjustment, and post-traumatic stress disorders in brain tumor patients

Abstract

Cancer patients often suffer from psychiatric disorders as a result of their disease and its treatment. Rates of depression, anxiety, adjustment, and post-traumatic stress disorders are particularly high for individuals with cancer and differentiating between these conditions is important for providing both appropriate and high-quality care. Patients with primary and metastatic brain tumors are particularly susceptible to psychiatric morbidities as a result of direct neuropsychiatric effects from the tumor itself, as well as psychological distress stemming from their diagnosis, prognosis, or treatment. However, these morbidities are often underdiagnosed, misdiagnosed, and undertreated. Many tools exist for screening, diagnosing, and treating psychiatric disorders in brain tumor patients, and palliative care settings are well suited to both identify and treat psychiatric disorders in brain tumor patients. This review summarizes our current knowledge of psychiatric disorders in patients in patients with brain tumors, highlights the susceptibility of brain tumor patients to psychiatric conditions, provides recommendations for differentiating and treating these conditions, and emphasizes the need for further research. The goal of this review is to inform healthcare providers of the opportunities to address psychiatric morbidities in patients with primary and metastatic brain tumors, particularly in palliative care settings, and identify areas in need of additional research.

Study of Association of Various Psychiatric Disorders in Brain Tumors

“…Early psychiatric intervention can substantially reduce mortality risk and improve symptoms of adjustment disorder while lowering the seizure frequency. 9,22,23 In the initial phase of the disease, impairment in neurocognition remains subtle and thus likely to evade clinical attention or misdiagnosed as a psychiatric disorder. 24,25 A neuropsychiatric syndrome, known as "disorders of diminished motivation" (DDM), is proposed to develop from the disorganization of dopaminergic pathways in various part of brain and is characterized by "impairments in goal directed behaviors."…”

“…Psychiatric disorders are often misinterpreted and undertreated, although it may have considerable influence over the psychological well-being of brain tumor patients. 9 20 It may lead to behavioral changes, increased suicidal tendency, low treatment adherence, longer recovery, and diminished survival. Moreover, caregivers are also predisposed to develop behavioral and personality changes.…”

“…Treatment protocols of brain tumor patients such as steroids, chemotherapy, radiation, and surgery further add on symptoms of depression and anxiety. 9 21 Recognizing and treating these disorders along with brain tumor pathology as integrated approach are crucial to improve the quality of survival period. Early psychiatric intervention can substantially reduce mortality risk and improve symptoms of adjustment disorder while lowering the seizure frequency.…”

“…In addition, brain tumor patients with psychiatric disorders may not have just diminished quality of life but overall survival also decreases. 9 10 Hence, identifying high risk patients early is crucial to provide adequate palliative care. Brain tumors can alter functions of the neural framework vital for synchronizing emotions, behaviors, and personality.…”

“… 11 12 These tumors with associated edema can further cause inflammatory changes that are often correlated with psychiatric manifestations due to more mass effect. 9 13 Therefore, some patients being treated for psychiatric disorders will eventually be detected with a brain tumor. 7 14 Considering the higher occurrence of psychiatric manifestations in brain tumors and probability of missing the diagnosis of tumor at an early stage, this study is planned to understand the psychiatric illnesses likely to be associated with brain tumors and its characteristics (location, radiological, and histopathological features).…”