A tumour in which of the following areas is most likely to lead to behavioural/psychiatric manifestation?
A. Frontal lobe tumours have been reported to be associated with psychiatric and behavioural symptoms in as much as 90% of cases. Frontal lobe tumours are associated with symptoms suggestive of mood disturbances and psychoses, including mania and hypomania, depression, catatonia, delusions, and hallucinations. Temporal lobe tumours cause psychiatric and behavioural symptoms in as much as 50–55% of the cases. Pituitary tumours cause psychiatric manifestations in as many as 60% of cases; parietal lobe – 15%; occipital lobe – 25%; and diencephalic tumours – 50%.
Which of the following is least associated with a frontal lobe tumour?
A. Frontal lobe tumours do not generally cause a decline in IQ. Tumours of the frontal lobes tend to produce symptoms that reflect their anatomical locations. They usually interfere with frontally mediated executive functions. Tumours involving the anterior cingulate are associated with akinetic mutism. Tumours involving the dorsolateral prefrontal convexities are typically associated with apathy, abulia, lack of spontaneity, psychomotor retardation, reduced ability to plan ahead, motor impersistence, and impaired attention and concentration. Patients with orbitofrontal tumours often exhibit personality changes, irritability and mood lability, behavioural disinhibition and impulsivity, lack of insight, and poor judgement. Tumours of the ventral right frontal lobe are often associated with euphoria. Tumours of the left frontal lobe often cause decreased speech fluency and diminished verbal output, word-finding problems, and circumlocutory speech, whereas tumours affecting both frontal lobes are often associated with confabulation, Capgras’ syndrome, or reduplicative paramnesias, or a combination of these. Kaplan HI.
Factors affecting the presence of neuropsychiatric symptoms in head tumours include:
E. The anatomical location of a tumour is an important factor that predicts the development of neuropsychiatric problems in the population. For example, left temporal lobe tumours are most commonly associated with psychosis. To some extent, the symptoms represent the underlying function of the involved lobe. The aggressiveness of the tumour itself and the rapidity and extent of its spread are also believed to be important factors in the type, acuity, and severity of psychiatric and behavioural symptoms that may be associated with it. Thus, rapidly growing tumours are frequently associated with more acute psychiatric symptomatology, as well as significant neurocognitive impairment. In this case, raised intracranial tension is associated with rapid growth and hence more behavioural problems. In general, the specific histological characteristics of brain tumours have not been shown to be correlated with specific psychiatric and behavioural symptoms. However, as noted previously, more aggressive tumours, such as high-grade gliomas, are more likely to be associated with acute psychiatric and behavioural symptoms than are slower growing malignant and benign tumours.
Which of the following has been found to be effective in the treatment of pathological laughing and crying (PLAC) syndrome?
C. Pathological emotions are characterized by episodes of laughing or crying, or both, that are not appropriate to the context. They may be spontaneous or triggered by non-emotional events. Pathological emotions have classically been explained as secondary to the bilateral interruption of descending neocortical upper motor neuron innervations of bulbar motor nuclei. Some patients with pathological emotions have bilateral lesions and pseudobulbar palsy, but others do not. Most recently, the frontopontocerebellar pathways have been implicated in the pathogenesis of pathological emotions. It is seen in about 15% of patients with stroke. Citalopram, as well as nortriptyline, have been found to be effective in the treatment of pathological crying after stroke in randomized placebo-controlled trials. In addition, post-stroke depression and PLAC appear to be independent phenomena, although they may coexist.
The lifetime prevalence of psychosis in patients suffering from epilepsy is around:
B. Psychosis is the specific psychiatric disorder most clearly associated with epilepsy. The lifelong prevalence of all psychotic disorders among epileptic patients ranges from 7% to 12%. Patients whose epilepsy has a mediobasal temporal focus are especially at risk. Studies on the laterality of the seizure focus suggest an association of a left-sided focus with psychosis. Although conclusions derived from surface EEG recording are open to criticism, depth recordings of presurgical patients show that twice as many patients with left temporal lesions have psychosis.
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