The psychopharmacology of primary and metastatic brain tumors and paraneoplastic syndromes

Handb Clin Neurol. 2019:165:269-283. doi: 10.1016/B978-0-444-64012-3.00016-2.

Abstract

Brain tumors and paraneoplastic syndromes can cause various neuropsychiatric symptoms. Rarely, psychiatric symptoms may be the initial presentation of the underlying neurologic lesion. Brain imaging studies are crucial in the diagnosis of brain tumors. Paraneoplastic syndromes are mostly immune-mediated, and antineuronal antibodies may be detected in the blood or cerebrospinal fluid. Clinical suspicion is very important in assisting the diagnostic workup. Treatment of the psychiatric symptoms depends on the nature of the symptoms. Selection of the psychotropic agent has to be done carefully to minimize complications such as seizures and delirium secondary to anticholinergic toxicity. With advances in targeted therapies, immunology, and genetics, the future appears more promising.

Keywords: Brain tumors; Limbic encephalitis; Paraneoplastic syndromes; Psychiatric symptoms; Psychopharmacology.

Publication types

  • Review

MeSH terms

  • Autoantibodies / blood*
  • Brain Neoplasms / blood*
  • Brain Neoplasms / drug therapy*
  • Humans
  • Immunologic Factors / therapeutic use
  • Limbic Encephalitis / blood
  • Limbic Encephalitis / drug therapy
  • Limbic Encephalitis / psychology
  • Paraneoplastic Syndromes, Nervous System / blood*
  • Paraneoplastic Syndromes, Nervous System / drug therapy*
  • Paraneoplastic Syndromes, Nervous System / psychology
  • Psychopharmacology
  • Psychotropic Drugs / therapeutic use

Substances

  • Autoantibodies
  • Immunologic Factors
  • Psychotropic Drugs