The Role of Neuropsychiatry in Meningioma Care: A New Perspective
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Transcript of The Role of Neuropsychiatry in Meningioma Care: A New Perspective
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The Role of Neuropsychiatry in Meningioma Care: A New Perspective
David Silbersweig M.D.Chairman, Department of Psychiatry
Chairman, Institute for the NeurosciencesBrigham and Women’s Hospital
Stanley Cobb Professor of PsychiatryHarvard Medical School
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Case Presentation• I present to you a case of woman in her 60s
who had a life long history of depression treated with antidepressants and psychotherapy
• In 2002, her depression significantly worsened prompting her first suicide attempt
• Her psychiatrist requested a neurologic consultation and brain MRI to evaluate for neurologic causes of her mood decompensation Newsweek, 2007
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Case Presentation• A small, 1cm meniongioma was detected but
was thought to be asymptomatic and of little initial concern
• Unfortunately, her condition further declined including two additional suicide attempts
• By 2006, she made her fourth suicide attempt and was now additionally experiencing weakness, memory trouble and language disabilities and continued depression
Newsweek, 2007
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Case Presentation• There was now repeated concern for neurologic
disease and a repeat MRI was obtained revealing a meningioma that had grown 6 times larger
• Patient had surgery to remove her tumor
• Her neurosurgeon wrote in follow-up: she has gone "from being completely unresponsive to a walking, talking, normal human being again."
Newsweek, 2007
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Case Presentation
Newsweek, 2007
“I celebrated that the tumor causeddepression was gone”
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Lessons Learned
• Neurologic disease can present with psychiatric symptoms
• Psychiatric symptoms can sometimes be the first manifestation of neurologic disease including meningiomas
• Neuropsychiatry can help provide a complete picture of mind-brain through an integrated understanding of Neurologic and Psychiatric disease
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What is Neuropsychiatry?
• Cognition • Emotion• Behavior• Perception • Experience
Neuropsychiatrists seek to understand symptoms in domains
In terms of:Localized brain dysfunction
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What is Neuropsychiatry?
• Basic Neuroscience • Human Functional Brain Imaging • Behavioral Neurology• Psychiatry• Cognitive psychology• Neuropsychology• Evolutionary psychology• Ethology
Knowledge base drawn from variety of related fields…
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Neuropsychiatry of Meningioma
• Symptoms can be related to– Mass effect
• Tumor, edema
– Seizures– Hydrocephalus– Treatments
• Post-surgical• Medical/pharmacological
– Psychological reactions, stress– Pre-existing conditions
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Frontal and Subcortical Neuropsychiatric Circuits
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Frontal and Subcortical Neuropsychiatric Circuits
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Neuropsychiatry of Meningioma
• Example # 1: Meningiomas at the junction of the frontal, temporal, parietal lobes (sylvian)
J.R.Coll.Surg.Edinb., 2001
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Possible Symptoms
1. Mood Disturbance (depression, mania)2. Impaired language production
• Difficulty understanding language• Difficulty with the emotionality of language
3. Hallucinations (auditory)4. Delusions5. Weakness
• Face or arm most common
6. Numbness(Laterality
dependent)
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Neuropsychiatry of Meningioma
• Example # 2: Meningiomas at the olfactory groove
R & S Physician, 2006
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Possible Symptoms• Changes in Smell
• Visual Disturbances
• Personality Change
• Disinhibited Behavior
• Mood Changes (mania more commonly than depression)
• State of Indifference (Apathy)
• Urinary Incontinence
• Slowed Movements
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Neuropsychiatry of Meningioma
• Example # 3: Midline (Parasagittal Meningioma)
Mod Pathol., 2002
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Possible Symptoms
• Leg Weakness
• Leg Numbness
• State of Indifference (Apathy)
• Urinary Incontinence
• Slowed Movements
• Mood Disturbances
• Personality change
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Treatment Options
• Patient:– Psychopharmacology– Psychotherapy/Cognitive Behavioral Therapy– Neuromodulation (e.g. TMS)– Cognitive Rehabilitation
• Family:– Improve disease understanding and coping– Targeted involvement of family in care of loved one– Evaluation and treatment for
stress/anxiety/depression, if needed
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BWH Institute for the Neurosciences
• “One-stop-shopping” for integrated, interdisciplinary care– Comprehensive consultation and diagnostic
evaluations• Neurology, neurosurgery, neuropsychiatry, neuroradiology,
neuropsychology, neuropathology, social work, rehab medicine/occupational therapy
– State-of-the-art, multi-faceted treatment plans• Medical, surgical, psychological, social
– Access to new therapeutic trials
• Unique scientific and educational brain-mind programs, led by world leading physician-scientists, at the interface of traditional academic medical fields
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Questions?
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Thank You