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=Brain Tumors And Psychiatric Symptoms=

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.In 18% of patients, neuropsychiatric symptoms may be the first clinical indication for brain tumors.Brain metastatic tumors may be associated with a higher incidence of psychotic symptoms, possibly due to tumor dispersion through the brain material.

Brain tumors can be neurological silence and only show mental symptoms. Early diagnosis and treatment are the key to determining the survival and quality of life of patients with brain tumors. Neuroimaging (CT and MRI) should be considered for new-onset psychiatric patients, recurrence of previously well-controlled psychiatric symptoms, the appearance of atypical symptoms, and the refractory nature of patients with psychotherapy.

History And Development
intracranial tumours with psychiatric symptoms are relatively rare but clinically important events. The practise of performing human autopsies for academic purposes ultimately led to the connexion between brain tumours and mental symptoms during the 16th and 17th centuries. Giovanni Battista Morgagni (1682-1771) was the first physician to describe a psychiatric patient and what a brain tumour might have been. . Recognizing this association was a slow process, mostly because of the paucity of practical ways to diagnose and treat psychiatric illness and brain tumors until the late 1800s. The movement led by the French physician Philippe Pinel (1745-1826) influenced physicians to think of psychiatric patients as sick human beings who did not deserve to be physically restrained or mistreated. The creation of large psychiatric hospitals that performed autopsies set the ground for the solid recognition of the association of brain tumors with psychiatric symptoms.

1879

The first successful brain tumor removal surgery documented as performed in 1879. At the same time, Wilhelm Wundt opens the first experimental psychology lab at the University of Leipzig in Germany.

1919

In October 1919, the American College of Surgeons was established, announcing neurosurgery as an independent surgical specialty. Five months later, on March 19, 1920, at the Peter Bent Brigham Hospital in Boston, USA. The Society of Neurological Surgeons, the world's oldest neurosurgery institution, was established.

1920

Electroencephalograms (EEG) in humans develop as a method to record activity in the brain at 1920.

1927

In 1927, Moniz (Portuguese) and his student Lima (neurosurgeon) showed the cerebral arterial system under the X-ray of carotid artery injection by dog animal experiment and autopsy, and then quickly extended to clinical application, according to vascular morphology changes. The location distribution to determine the location and nature of intracranial lesions, making the diagnosis of intracranial lesions more accurate, and can have a more direct significance for the diagnosis of cerebrovascular diseases such as cerebral vascular malformations, aneurysms, cerebrovascular embolism.

1938

In1938 MOSES KESCHNER, M.D MORRIS B. BENDER, M.D. and ISRAEL STRAUSS, M.D reviewed 530 verified patients and published the earliest study about association between brain tumor and psychiatric symptoms. The purpose of this study is to the investigation was to ascertain the frequency of occurrence, the nature and the localizing value of mental symptoms in cases of tumor of the brain. Mood disturbance includes depression and anxiety across 43% of 530 patients.Hallucinations were observed most frequently in patients with supratentorial tumors, they were recorded in 103 instances, which is 19 percent of the total patients.Disturbances in memory are predominantly more frequent in individuals with supratentorial tumor than in those with infratentorial tumor.They didn’t find any mental symptoms that are specific for brain tumors.But they found mental symptoms are almost twice as a frequent inpatient with supratentorial as in those with an infratentorial tumor of the brain.

1935-1950

Lobotomy was mainly used to treat some mental illnesses from 1930 to 1950, which is also the world's first psychiatric surgery. Lobotomy is a neurosurgical procedure for removing the connective tissue of the prefrontal cortex of the brain. Treatment subjects include schizophrenia, clinical depression, and some anxiety disorders, as well as those who are thought to have signs of mental illness (such as moodiness, frivolity).The technology won the 1949 Nobel Prize in Physiology or Medicine. However, patients are likely to develop mental illness after surgery.

Common Types Of Brian Tumor
There are two major types of brain tumors: primary and secondary. The primary tumor is divided into intramedullary and extramedullary. Intramedullary tumors mainly include glioma, neuroblastoma, and interstitial mesenchymal tumors. Qualitative tumors, epithelial tumors, teratomas, and pineal tumors.

Glioma
Glioma is a tumor derived from neuroepithelial cells. It is the first of various types of tumors in the brain. Its incidence accounts for 40% to 45% of intracranial tumors. Astrocytoma and astrocytes are common. Tumor, pleomorphic glioblastoma, medulloblastoma, oligodendroglioma, oligodendroglioma, choroid plexus papilloma, pineal tumor, etc.

Meningioma
Meningioma is the second most common intracranial tumor after glioma, accounting for about 20% of the total number of intracranial tumors. Meningioma has the characteristics of superficial parts, slow growth, and a clear boundary with brain tissue. Most meningiomas are benign. The tissue morphology of tumors can be divided into two types: endothelial cell type and fiber type. Meningioma is derived from arachnoid endothelial cells, with the most prominent brain, sagittal sulcus and cerebral palsy, followed by sphenoid ridge, saddle nodule, olfactory sulcus, cerebellum and posterior fossa. . Can occur at any age, but the elderly and children are rare.

Imaging
In general, The diagnosing of a brain tumor usually begins with medical imaging.The most common imaging method includes magnetic resonance imaging (MRI) and computed tomography (CT) scans, once MRI or CT scan s show there is a tumor in the brian the most common ways is to determine the type of brain tumor is to look at the results from a sample of tissue after a biopsy or surgery.

MRI
Magnetic resonance imaging is a type of tomography that uses electromagnetic resonance to obtain electromagnetic signals from the human body and reconstruct human body information. Like PET and SPECT, the magnetic resonance signals used for imaging come directly from the object itself. It can also be said that magnetic resonance imaging is also an emission tomography. But unlike PET and SPECT, magnetic resonance imaging can be imaged without the injection of radioisotopes. This also makes MRI technology safer. Magnetic resonance imaging (MRI) has been applied to the imaging diagnosis of various systems throughout the body. The best effect is the brain, its spinal cord, large blood vessels, joint bones, soft tissues and pelvis. Cardiovascular disease can not only observe the anatomical changes of each chamber, large blood vessels and valves, but also can be used for ventricular analysis, qualitative and semi-quantitative diagnosis, can be used as multiple cut charts, high spatial resolution, showing heart and lesions. The overall appearance, and its relationship with the surrounding structure, is superior to other X-ray imaging, two-dimensional ultrasound, radionuclide and CT examination. Coronal, sagittal and cross-sectional images can be used in the diagnosis of cerebrospinal lesions. The main shortcoming of magnetic resonance imaging is that it takes a long time to scan, so it is often difficult to check for some patients who do not cooperate. It is often unclear for the lack of suitable contrast agents in sports organs, such as the gastrointestinal tract. For the lungs, the imaging effect is not satisfactory due to respiratory movements and low hydrogen proton density in the alveoli. Magnetic resonance imaging is not as accurate and sensitive as CT for calcification and skeletal lesions. The spatial resolution room of magnetic resonance imaging needs to be further improved.

CT
Computed tomography (CT) can accurately detect small differences in density between different tissues on a transverse anatomical plane. It is an ideal method for observing bone and soft tissue lesions. CT is superior to traditional X-ray examination in that it has high density resolution and can also perform axial imaging. Due to the high density resolution of CT, soft tissues, bones and joints can be seen clearly. In addition, CT can do axial scanning, and some joints that are difficult to distinguish on conventional X-ray images can be "original" on the CT image. CT examination has a high diagnostic value for central nervous system diseases and is widely used. It has a good diagnostic effect on intracranial tumors, abscess and granuloma, parasitic diseases, traumatic hematoma and brain injury, cerebral infarction and cerebral hemorrhage, as well as intraspinal tumor and intervertebral disc prolapse. The diagnosis is reliable. Therefore, X-ray angiography of the brain, in addition to cerebral angiography, is still used to diagnose intracranial aneurysms, vascular dysplasia and cerebral vascular occlusion, and to understand the blood supply artery of brain tumors. Others such as gas brain and ventriculography have been used sparingly.

PET
PET scan is a type of nuclear medicine scan. It was an instrument invented in 1974. After more than 20 years of being positioned as a research tool, it finally broke through the strict review of the US HCFA (health of the Health Care Financing Administration changed to CMS, Centers for Medicare & Medicaid Services) in 1997. Finally, in the clinical application, Chan released beautiful flowers. In other words, it is regarded as affirmation, recognition and acceptance by the medical community.

Biospy
Biopsy also known as surgical pathology. It refers to the technique of taking out, puncturing or puncture the diseased tissue and performing pathological examination.It is the most important part of diagnostic pathology, and a clear histopathological diagnosis can be made for most cases, which is used as the final clinical diagnosis. There are four founctions of biospy.

(1) Assist in clinical diagnosis of the lesion or provide clues for the diagnosis of the disease.

(2) Understand the nature and development trend of the lesion and judge the prognosis of the disease.

(3) Verify and observe the efficacy of the drug, and provide reference for clinical drug use.

(4) Participate in clinical research, discover new diseases or new types, and provide pathological histological basis for clinical research.

Lumbar Puncture Or Spinal Tap
Lumbar puncture is a commonly used diagnosis and treatment operation in clinic. It can be used to diagnose various inflammatory diseases of the central nervous system, vascular diseases, spinal cord lesions, suspected intracranial space-occupying lesion s, neurological diseases with unknown diagnosis, and cerebrospinal and spinal angiography. It is also used for pressure on cerebrospinal fluid, High drainage (decompression) and infusion of drugs for central nervous system diseases. Lumbar puncture has two main purposes (A) for diagnosis: 1, taking cerebrospinal fluid for testing. 2. Measure brain pressure and understand the intracranial pressure. 3. Perform cerebrospinal fluid dynamics examination. 4. Perform spinal cord or gas brain angiography.(B) for treatment: 1, drainage of cerebrospinal fluid. 2, remove cerebrospinal fluid, reduce intracranial pressure. 3. Intrathecal injection of drugs to treat inflammation or tumors.

ICD-10 Chapter V
International Classification of Diseases (ICD) is an internationally harmonized disease classification method developed by WHO. It classifies diseases according to their etiology, pathology, clinical manifestations and anatomical location, making them an ordered combination and coding. The way to represent the system. Commonly used worldwide is the 10th revised International Statistical Classification of Diseases and Related Health Problems, which still retains the abbreviation of ICD and is collectively referred to as ICD-10.

DSM-5
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), is a guidebook most commonly used to diagnose mental illness in the United States and other countries.DSM contains descriptions, symptoms, and other criteria for diagnosing mental disorders. .

Common Psychiatric Symptoms
(1) Sensory disorders include hypersensitivity, hypotension, inversion, and lack of internal sensation.

(2) Perceptual disorders include illusions, illusions, hallucinations, and perceptual syndromes.

(3) Thinking obstacles include thinking, running, slow, poor, slack, pathological, non-coherent, interrupted, gathering, symbolic thinking. Logic inverted thinking, sophisticated thinking, continuous repetitive imitation, stereotypes and other words, as well as thinking delusions, interpretations of delusions, visual reverie. Thinking insertion and so on.

(4) Attention barriers include active attention disorder and passive attention disorder.

(5) Memory disorders include memory enhancement, decline, forgetting, misconstruction, fiction, latent memory and deja vu.

(6) Intelligent barriers are divided into congenital intelligence can be low, acquired acquired dementia.

(7) Emotional disorders include experiences and expressions of joy, anger, sadness, happiness, love, jealousy, sadness, and anxiety. Common emotional disorders: high emotions, euphoria, depression, anxiety, vulnerability, excitement, dullness, apathy, inversion, terror, contradiction, etc.

(8) The behavioral disorder of will includes enhancement, decline, lack, inversion, contradiction, stupor, violation, and stereotypes, imitation, behavior and bizarre behavior.

See also: https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968

Psychiatric Symptoms Before Brian Tumor
A study supported by the federal Cancer funding records100 inpatients (35 female, 65 male; mean age=51.7±17.4) from the neurosurgery unit to bring to light psychiatric symptoms present before the brain tumor diagnosis. They investigated the influence of the following factors: gender, educational level, age, brian tumor volume, brian tumor localization and nature, clinical symptoms. The result indicates 45/100 patients presented psychiatric symptoms (mostly anxious or depressive) before the brain tumor was diagnosed. The psychiatric symptoms reported before brain tumor diagnosis including Depression-anxiety, euphoria-disinhibition, mixed mood disorder, appetite disorder, slower reactions and thinking, behavior change, psychotic symptoms, memory and attention disorder, sleeping disorder.

Anorexia Symptoms And Hypothalamic Tumors
The study from 1984 has found brain tumors are up to ten times more common in psychiatric patients.A meta-analytic study of reports of brain tumors and psychiatric symptoms for the past 50 years was conducted by multiple researchers to examine potential associations between tumor location and psychiatric symptoms .The purpose of this study is to the investigation was to ascertain the frequency of occurrence, the nature and the localizing value of mental symptoms in cases of tumor of the brain. A total of 148 cases, including 12 case series of brain tumors presenting with psychiatric symptoms, were initially identified.The most common tumor locations were frontal, including frontoparietal and frontotemporal areas (23.6%), and temporal, including temporoparietal areas (12.2%). Different tumor locations were associated with varied psychiatric symptomatology. However, most of the hypothalamic tumors were characterized by anorexia symptoms (89%). Mood symptoms (depression/mania) were the most common psychiatric manifestations and were found in 36% of case reports. The next common symptoms were memory disturbances, occurring in 24% of cases. Psychotic symptoms were noted in 22% of cases, mostly occurring in cerebral cortical, pituitary, pineal, and posterior locations. Interestingly, delirium was only noted in 4% of the cases. In previously published studies, personality changes have been described in 70% of patients with frontal lobe tumors and 50% of patients with temporal lobe tumors. Results of the statistical analysis demonstrate that anorexia symptoms associated with brain tumors are not distributed equally based on the anatomical region (Pearson F: 32.21; significance value of <0.01). When data from tumors located in the hypothalamus is specifically analyzed, the results are highly suggestive of a correlation between anorexia symptoms and hypothalamic tumors (relative risk: 17.56; 95% CI: 6.57–46.89;  p-value >< 0.01). There is a statistically significant correlation of anorexia symptoms with hypothalamic tumors. Previous reports also demonstrated that 62.5% of cases of hypothalamic tumors were associated with anorexia symptoms.