肿瘤卒中与精神症状.ppt

肿瘤、卒中与精神症状,深圳市康宁医院 急性干预科女二区,The most common tumor locations were frontal, including frontoparietal and frontotemporal areas (23.6%), and temporal, including temperoparietal areas (12.2%). Different tumor locations were associated with varied psychiatric symptomatology, however, most of the hypothalamic tumors were characterized by anorexia symptoms (89%).,肿瘤部位,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. delirium was only noted in 4% of the cases.,精神症状,There is a statistically significant correlation of anorexia symptoms with hypothalamic tumors（52%-62.5%）. The second finding in our current analysis was the association of an increased likelihood of psychosis with pituitary tumors compared with pineal gland tumors, memory (recall) difficulties with thalamic tumors compared with corpus callosum and mood symptoms with frontal lobe compared with temporal lobe tumors.,肿瘤部位和精神症状关联,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. Subcortical neoplasms can result in significant impairment in the retrieval of learned material and detailed neuropsychological evaluation may identify a pattern of subcortical dementia. In a comparative study, more depressive symptoms were noted in tumors of the corpus callosum. Depression was noted more commonly in frontal lobe tumors and psychosis in temporal lobe neoplasms.,肿瘤部位和精神症状关联,结论,The meta-analysis revealed that there was a significant relationship between PSD and right hemisphere lesions when depression was assessed within 16 months after stroke. OR = 0.79,卒中后抑郁,Patients with vascular depression have later age at onset, greater cognitive impairment, less family and personal history of depression, and greater physical impairment than geriatric patients with nonvascular depression. In addition, patients with vascular depression with executive dysfunction and/or patients who show progression of white matter hyperintensities over time have a poor response to treatment with antidepressants and a more chronic and relapsing clinical course .,the cumulative percent of patients who developed one or more depressions within the first 5 years following stroke ranged from 39% to 52%。,危险因素,Increased mortality associated with PSD,The American Heart Association recommends the use of antidepressants for PSD, which should be continued after recovery for at least 6 months. PSD has been the demonstration of preventive treatment.,卒中后精神病,Prevalence and incidence rates,estimated prevalence rate for delusions was 4.67% hallucinations was 5.05% combined prevalence of 4.86%,Reported an average time to onset for psychosis of 6.1 months over a follow-up period of 10 years. traumatic brain injury (TBI) have also reported a significant delay from point of insult to psychosis onset, with psychosis becoming more likely 23years the index injury,Delayed onset of psychosis,Stroke type is not a predictor of subsequent psychosis The average age for the occurrence of poststroke psychosis was 66.6 years, and it occurred more often in men than in women. The most common presenting neurological signs and symptoms accompanying poststroke psychosis were left-sided weakness, headache and slurred speech.,临床特征,The majority of patients were found to have right hemisphere lesions, in line with that suggests right hemisphere pathology is associated with a range of perceptual anomalies and pathologies of belief. Mirroring findings in psychosis after TBI. Left hemisphere strokes are more likely to result in language and communication problems. Darby et al used lesion network mapping in 17 stroke patients with misidentification delusions, identifying the left retrosplenial cortex as the only brain area functionally connected to all lesion sites, potentially highlighting its role in the aetiology of poststroke psychosis.,卒中部位,The most common types of psychosis were, in order of frequency, delusional disorder, schizophrenia-like disorder and mood disorders with psychotic features. In terms of delusional theme, persecutory delusions were the most common, followed by delusional jealousy (Othello syndrome), reduplicative paramnesia and somatic delusions.,症状,The majority of patients did not have a previous psychiatric history,inconsistently reported. Other risk factors included hypertension, hyp