Psychiatric Manifestations of Frontal Lobe Tumours

Abstract

In a recent article in the British Medical Journal Maurice-Williams & Dunwoody (1988) reported two patients with frontal meningiomas who presented initially to psychiatrists. The correct diagnosis was made in one of them after prolonged, perhaps unnecessary, psychiatric treatment. In the other the diagnosis was made at autopsy. In this case psychiatrists were only briefly involved and neurosurgical referral had been made promptly. The authors, who treat these reports as a cautionary tale, conclude by warning psychiatrists to pay special attention to a number of features in the history and examination of psychiatric patients. In particular we are told that suspicion should arise in the presence of gradual non-remitting symptoms such as irritability, memory loss, self-neglect, dysphasia or incontinence in patients without a previous history of psychiatric disease or clear precipitating factors. They also suggest that we pay attention to the views of relatives when they feel the patient suffers from a physical rather than a psychiatric illness, and emphasise that early diagnosis leads to easier surgical removal and better outcome.

Prognostic Implication of Preoperative Behavior Changes in Patients with Primary High-Grade Meningiomas

“…Nevertheless, studies have reported no raised incidence of intracranial tumors among patients manifesting schizophrenia, affective illness, or neurotic symptoms [27]. A very small incidence of positive radiological findings in psychiatric patients, except for brain atrophy, does not give good reason for routine CT and MRI brain scans in all hospitalized psychiatric patients [28].…”

Diagnosis of dementia. II—Diagnostic methods: A survey of current consultant practice and review of the literature

“…Mental changes, including dementia, are commonly seen in patients with cerebral tumours (Lishman, 1987; Ron, 1989). Their occurrence is influenced by: the site, being commonest in frontal lobe; the type of tumour, the more invasive (usually malignant) the more commonly they are seen (Hacaen and Ajuriaguerra, 1956); the presence of raised intracranial pressure; and the rate of growth of the tumour (Lishman, 1987).…”

Posterior Fossa Tumours Presenting to Psychiatrists

“…The classical descriptions of mental abnormalities in brain tumours (Ron, 1989) fall into three broad categories; confusional states, mood or behaviour disturbances mainly of organic type and paroxysmal disturbance. The above two cases do not fit these categories but comprise the rarer group of those who seem to have well defined "functional" disorders.…”

“…So far most of the attention has concerned the anterior fossa, particularly the frontal lobe (Ron, 1989;Maurice Williams and Dunwoody, 1988). There are goods reasons for this.…”