Secondary Schizophrenia (107 page)

slowly growing tumors such as meningiomas. Ulti-Psychiatric complications may arise from specific
mately, the decision to utilize neuroimaging needs to
treatment directed against the brain tumor. In par-take into account both the current presentation and
ticular, steroids used to control peritumor edema
all the possible organic factors contributing to the pre-may result in psychosis. Psychotic symptoms may be
sentation. Equally important is the retention of clini-a clinical manifestation of delirium resulting from
cal vigilance in the patient with established psychotic
chemotherapeutic agents, intracranial irradiation, or
symptoms who now presents with a changed clinical
metabolic or electrolyte disturbances related to the
picture.

cerebral tumor. In this case, the underlying cause of
The treatment literature available to clinicians spe-

268

delirium needs to be identified and addressed.

cific to this setting is poor. Evidence relating to the
Chapter 20 – Brain tumors

influence of treatment of the underlying tumor on the
ing modern diagnostic criteria. A more precise epi-psychotic symptoms is conflicting, probably reflect-demiologic survey would give clinicians more infor-ing the diversity of tumor types, tumor treatments,
mation on which to base their decisions to investi-and other risk factors present in any given case. Treat-gate and how to investigate looking for the presence
ment needs to be appropriately tailored given the likely
of a brain tumor. This same methodology may pro-higher sensitivity to side effects in this population.

vide more accurate understanding of the complex-Careful consideration also must be given to the most
ities of the relationship between brain tumors and
appropriate locus of treatment – the presence of psy-psychosis, leading to hypothesis-driven exploration
chotic symptoms can cause great alarm on the neuro-of the etiologic link. It would appear unlikely that a
surgical ward and the presence of a patient with a brain
broad survey of this diverse area is likely to lead to
tumor can equally cause great anxiety on the psychi-greater understanding of how a tumor in an individ-atric unit!

ual leads to psychosis. Finally, greater research into
the treatment of psychosis in this setting is required.

Suggestions for future research

Although sufficient data to provide a full evidence
base would be difficult to accumulate, greater direc-Future research in this area could usefully examine
tion to management is sorely needed. For patients
a number of issues. Although many previous stud-and their families, the combination of psychosis and
ies have focused on the broad relationship between
a brain tumor is likely to present unique emotional
psychiatric symptomatology, including psychosis, and
challenges – challenges clinicians would prefer to face
brain tumors, the literature is still relatively poor
armed with adequate information to assist in their
in examining the specifics of this relationship utiliz-response.

269

Organic Syndromes of Schizophrenia – Section 3

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