Using Teamwork To Cope
In all cases, it is important to notify your medical team about behavior changes. Chronic illness of a family member can cause emotional distress to the entire family. Dr. Kayl recommends an active role of patients and caregivers in finding ways to cope. The bottom line for all interventions is this: there is no magic bullet. Each patient will bring different strengths and weaknesses to the table. Its up to the doctor-patient-family team to develop realistic and attainable goals for coping with cognitive and behavioral changes. What works for one person may not work for another. These are the differences that make us human.
This article was reprinted with permission from Search, Issue #57 . For more information, contact the National Brain Tumor Foundation at 800.934.2873 or visit www.braintumor.org.
Caring For A Loved One With A Brain Tumor
Family members and friends often play an important role in taking care of a person with a brain tumor. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away. Being a caregiver can also be stressful and emotionally challenging. One of the most important tasks for caregivers is caring for themselves.
Patients with a brain tumor often need a lot of support at home. Many patients may not be able to do activities important for their care, such as driving to and from appointments. And some may need modified living arrangements to accommodate physical challenges. This means that caregivers have a range of responsibilities on a daily or as-needed basis, including:
Providing support and encouragement
Talking with the health care team
Helping manage symptoms and side effects of the tumor and treatment
Coordinating medical appointments
Helping with household chores
Handling insurance and billing issues
Anticipating changes in mood, personality, and thinking and knowing how to best cope with these changes
A caregiving plan can help caregivers stay organized and help identify opportunities to delegate tasks to others. It may be helpful to ask the health care team how much care will be needed at home and with daily tasks during and after treatment. Use this 1-page fact sheet to help make a caregiving action plan. This free fact sheet is available as a PDF, so it is easy to print.
Key Questions About Depression Everyday Health
10 Key Questions About Depression.
Posted: Mon, 18 Feb 2008 08:00:00 GMT
In major depression, mood and/or rate of interest are decreased for most of 2 weeks. For kids, some research study has actually sustained using can a brain tumor cause depression and anxiety the SSRI antidepressant fluoxetine. The benefit nonetheless appears to be mild in kids, while other antidepressants have not been shown to be efficient.
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Vision Problems: Loss Of Vision Or Double Vision
Seeing floating shapes in front of your eyes, seeing everything double, or losing vision on and off may all indicate tumors in different parts of the brain.
- Blurred sight, vision loss that comes and goes, or seeing floating shapes like small dots or thin strands in front of your eyes can all indicate a tumor.
- A tumor in the occipital lobe may mean loss of vision in one eye or sometimes both eyes.
- A tumor in the brain stem may cause double vision.
- Pituitary tumors or adenomas affecting the optic nerve may lead to loss of field of vision,6 which means your peripheral vision may be affected. In simple words, if you are staring straight ahead, you will be able to see only whats directly in front of you and not sideways, almost as though you were looking through a tunnel. This is why this type of vision loss is also known as tunnel vision.
- Sometimes, flickering or twitching eyes may also be a sign of a tumor in the cerebellum. An eye twitch can also be caused by these 7 factors.
Anxiety And Depression Could Be Signs Of Brain Tumor
Psychiatric symptoms like mania, hallucinations, and depression may signal a brain tumor, according to doctors who diagnosed a 54-year-old woman with treatment-resistant depression.
The patient, who was not named for confidentiality of the case study, had stopped showing interest in her past hobbies. She spent more time in bed and always felt irritable. Tests show no abnormality so doctors initially prescribed antidepressants.
All treatment options did not work. After six months of being in a depressive mood, doctors found she had several tumors in her brain shown through MRI and CT scans. These tumors were found in her left frontal lobe, which is linked to depressive symptoms.
In the case report published in BMJ Case Reports, doctors found the patient had meningiomatosis or multiple meningiomas. Meningiomas are tumors that grow from the meninges, the membranes surrounding the brain and spinal cord. A big meningioma was found in her left frontal lobe.
The woman underwent surgery to remove the tumor. Though the tumor was benign, it caused alterations in her emotions because it was attached to her frontal lobe.
“Depressive symptoms may be the only expression of brain tumors. Thus, it is challenging to suspect a brain tumor when patients with depression have a normal neurological examination,” the doctors wrote in the case report.
“This case highlights the importance of identifying signs of brain tumour in patients with depression,” they added.
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Patient And Public Involvement
None of the study participants was involved in the design or conduct of this study and no patient opinion regarding the study has been obtained. The results have been reported to head of mind and brain service line at Aga Khan University Hospital in Karachi which primarily deals with neuro-oncology patients.
Diagnosing And Treating Psychiatric Disorders In Patients With Brain Tumors
The presence of certain risk factors can indicate the need for additional screening and evaluation. Large tumors , pituitary tumors, and meningiomas all carry high risks of depression and anxiety symptoms. Cognitive impairment and seizures that result from brain tumors, along with treatments such as glucocorticoids, also put patients at risk . From a psychosocial standpoint, cancer patients who are younger, have functional limitations, and lack social support are at increased risk for depression, while past trauma, demoralization, and metastasis can increase risk for anxiety. Cancer patients from certain marginalized and minority populations and patients with a history of mental health issues are also more likely to have cancer-related depression or anxiety . Research focused on brain tumor patients specifically indicates that female gender, lower tumor grade, lower education level, and a history of psychiatric illness all predict anxiety and depression . Healthcare providers should be aware of these risk factors when screening brain tumor patients for depression and anxiety disorders.
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How Can Cancer Cause Depression
In a paper published this week in the Proceedings of the National Academy of Sciences, Dr Leah Pyter and her colleagues at the University of Chicago started with the idea that depression in cancer patients could have three main causes.
Firstly, as mentioned above, finding out you have cancer can, in and of itself, make you depressed for reasons we can all understand and empathise with.
A second reason could be the unpleasant side-effects of cancer therapy. Chemotherapy, radiotherapy and surgery, despite saving lives, all have effects that can alter our mental well-being.
But the US researchers propose that chemicals produced by the cancer itself could be involved. Cancer cells secrete a range of chemicals that affect how our bodies work, so its not that far-fetched to think that they could affect how we think and feel.
Dr Pyter and her colleagues set out to see if they could detect any such mood-altering chemical changes.
In a series of experiments, they compared the behaviour and brain chemistry of healthy rats with those that had developed breast cancer.
Clumsiness: Loss Of Balance And Coordination
Loss of balance, lack of coordination in the limbs, trouble swallowing, and numbness or weakness in one side of the body can be because of brain tumors.
If you are finding it difficult to maintain your balance while walking or having difficulty coordinating your hands and legs, it might be a symptom of brain tumor. This might be caused by a tumor in the cerebellum, the primary motor cortex, or the parietal lobe, all of which are responsible in different ways for the coordination of movements. A brain stem tumor that affects hearing can also contribute to loss of balance.
If your clumsiness can be attributed to numbness or weakness in one side of your body, it might be caused by a tumor in the parietal lobe. As the brain stem and the frontal lobe control muscular movements related to swallowing and speaking, respectively, patients also have trouble with these activities if they get tumors in these areas.
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A Family History Of Depression
We now have a better understanding of why some people are more likely to become depressed than others. One reason is a family history.
If you have a close relative who has had depression, you are more likely to get depressed yourself when faced with a period of stress.
Sometimes the chemical changes in the brain that go with depression are long lasting. This means that after recovering from an episode of depression, you are more prone to depression being triggered in the future.
National Institute for Health and Care Excellence , March 2004
Prevalence of depression in patients with cancer
Frequent Confusion & Cognitive Issues
Feeling constantly confused, loss of concentration, memory loss, and disorientation are common cognitive issues patients with a brain tumor can experience. Depending on the location of the tumor, it can begin to affect cognitive performance due to the pressure the tumor is putting on these specific areas of the brain. Naturally, declining cognitive abilities are a sign of other neurological conditions such as Alzheimers disease and dementia, meaning that a decline in brain function does not necessarily indicate a brain tumor. However, noticeably declining cognitive abilities and various cognitive problems are critical symptoms that need to be reported to a medical professional as soon as possible so that the initial cause of these cognitive issues can be assessed, diagnosed, and treated as soon as possible.
Brain tumor symptoms largely depend on the location of the tumor within the brain. Reveal why location is significant in diagnosing a brain tumor now.
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Abnormal Physiological Changes: Large Limbs And Irregular Periods
If your hands and feet are suddenly getting larger, even after youve crossed the growth years, scan for a pituitary tumor.
A tumor in the pituitary gland can cause irregular periods, excessive production of breast milk, development of breasts in men, and excessive body hair. It may also lead to the enlargement of your hands and feet, obesity, and changes in your blood pressure.12 A drooping eyelid or a drooping mouth can indicate a tumor in the brain stem.
Susceptibility Of Brain Tumor Patients To Psychiatric Morbidities
Table 2Full table
Finally, headaches are a common symptom in patients with brain tumors and are often treated with opioid analgesics . Opioids have the potential to cause serotonin toxicity or serotonin syndrome which can result in altered mental status and numerous other symptoms, particularly when combined with psychiatric medications such as SSRIs/SNRIs. Consequently, other medications such as triptans have been recommended for headache treatment, which are safer to use for patients taking SSRIs/SNRIs . The risk of serotonin syndrome with opioid medications should also be considered in cases of general pain management, particularly in palliative care settings.
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Side Effects Of Medications
Steroids such as dexamethasone are commonly prescribed to manage edema. Steroids can cause patients to feel anxious, restless, or depressed. In such cases, the doctor may decrease the dosage or may prescribe anti-psychotic medication to control side effects.
Similarly, anti-epileptic drugs can cause unwanted side effects if the doses are too high or too low. AEDs can also react with chemotherapy drugs such as procarbazine and BCNU. These drug interactions can result in sleepiness, depression, confusion, and problems with gait, speech, and vision. Occasionally, symptoms include aggression, insomnia, and psychosis. A doctor may change the dosage or the type of AED to resolve these side effects.
Aggressive Or Combative Behavior
Some behaviors present special challenges. In rare cases, a person can suffer from agitation or paranoia. Behavior can become aggressive or combative. These behaviors can be caused or intensified by various medications. Doctors manage these symptoms by modifying drug dosages, or by prescribing antipsychotic drugs or tranquilizers.
Aggressive behavior is particularly difficult when safety becomes an issue. The best strategy is to pay attention to warning signs of growing anger or threats of violence. Tell your doctor, and try to resolve the problem before it escalates.
When dealing with an agitated person: Try to create a calm environment. Reduce noise, bright lights, excess movement, and the number of people in the vicinity. Alternately, remove your loved one from stressful situations.
Speak calmly and maintain eye contact. Assure the person of his or her safety. Orient the person by identifying yourself and stating your intentions.
Find out if something specific is bothering the person and resolve the problem. For example, the person may be hungry, thirsty, tired, afraid of something, or need to go to the bathroom. Try to calm the person by encouraging him or her to talk and by listening to his or her complaints. Dont disagree or argue with the person. Let the person talk until he or she calms down.
If the person becomes combative, remain calm. Take a few steps back and give the person plenty of room. Continue to agree and assure the person that he or she is safe.
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Differentiating Psychiatric Disorders In Cancer Patients
There is a growing body of evidence that demonstrates a high prevalence of psychiatric morbidities associated with cancer. Most of this data comes from either self-reported questionnaires or structured clinical interviews. Questionnaires are useful for initial screening and estimating the prevalence of psychiatric conditions for various cancers however, they can overestimate actual rates and rely solely on patient interpretations of questions . Numerous studies have validated the clinical use of questionnaires, such as the PTSD Checklist Civilian Version , the Patient Health Questionnaire , and the General Anxiety Disorder-7 questionnaire for screening cancer patients . However, structured clinical interviews are the gold-standard for diagnosing cancer patients with depression, anxiety, AD, or PTSD . Unlike questionnaires, clinical interviews can determine etiology and assess the exact nature and functional impact of symptoms. This is important for evaluating whether the disorder is directly related to a patientâs cancer diagnosis or is a comorbid condition that developed separately before or during cancer care.
Strengths And Limitations Of This Study
To our knowledge, this was the first study conducted in Pakistan to explore depression and its associated factors among patients with primary brain tumour.
The study has assessed those associations which were not assessed in any of the previous studies on a similar population including treatment stage, extra ventricular drain insertion, number of admissions, stressful events, strategies use to handle stress and first symptoms. Moreover, the relation of different costs including travelling cost and overall treatment cost with depression was also evaluated in this study.
A single screening tool to measure depression instead of physician-rated measures or mini-interviews was used to verify the results of Patient Health Questionnaire-9.
The study design is cross-sectional which limits both temporality and direction of causation.
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Coping With Anxiety & Depression
Feeling anxious from the tumor or treatment is very common, but it makes every situation feel more intense. Often, depression is felt with anxiety. Treatments include relaxation techniques, antianxiety and/or antidepressant medications and counseling. Talking about how you feel with someone skilled in relieving emotional problems can absolutely help.
- Symptoms of anxiety include: rapid heartbeat, fear, restlessness, nervousness, and sweaty palms. If you feel anxious it is important to talk about it. Its the first step to regaining control in your life.
- Symptoms of depression include: feeling irritable, hopeless and unable to concentrate, withdrawn and moody. Some people wish to harm themselves. Depression is serious. It can and should be treated on its own.
Most people say that their mood improves as the symptoms and side effects of a brain tumor or its treatment are managed and go away.
Symptoms Of A Pituitary Tumor
Many pituitary tumors never cause any symptoms. When they do, the symptoms can be attributed to three different causes:
- Growth of the tumor, causing pressure on nearby brain structures
- Damage to the pituitary gland, and a decrease in or loss of the glands ability to produce hormones
- Excess hormones produced by a functioning tumor
A tumor that grows large enough to press against adjacent brain structures may cause:
When the tumor disrupts the pituitarys ability to produce hormones, symptoms may include:
- Weight gain or loss
- Increased thirst and urination
When a functioning tumor produces hormones, the extra hormones can cause symptoms based on which hormone is being produced in excess:
- Prolactin-producing pituitary tumors can affect libido, sexual function, fertility.
- Adrenocorticotrophic hormone-producing pituitary tumors can cause depression and anxiety, easy bruising, weight gain, acne, and muscle weakness, high blood sugar and blood presure.
- Growth hormone-producing pituitary tumors can lead to a condition known as acromegaly, with excess growth of hands, feet, jaw, heart enlargement, high sugar, blood pressure.
- Thyrotropin-producing pituitary tumors can cause palpitations, tremor, weight loss, and insomnia.
Reviewed by: Georgiana Dobri, M.D.Last reviewed/last updated: December 2020
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