Aggression in a patient with primary brain tumor: ethical implications for best management

Villanó, John L.; Mlinarevich, Nada; Watson, Karriem S.; Engelhard, Herbert H.; Anderson-Shaw, Lisa

doi:10.1007/s11060-009-9850-3

Cited by 10 publications

(1 citation statement)

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“…Research focusing on malignant tumor patients specifically has described neuropsychiatric symptoms including agitation, irritability, apathy, and hallucinations ( 5 , 19 ). Single-case reports ( 20 ) and first-hand accounts of relatives documented in qualitative studies ( 21 – 23 ) have also been published, reporting aggression, personality change, and erratic emotional behavior among patients with low- and high-grade malignant tumors. A handful of group studies have reported rates of behavior change between 16% ( 24 ) and 62% ( 25 ) among patients with oligodendrogliomas ( 24 ), primary and metastatic brain tumors ( 25 ), and survivors of acromegaly ( 25 ).…”

Section: Introductionmentioning

confidence: 99%

Frequency, Clinical Correlates, and Ratings of Behavioral Changes in Primary Brain Tumor Patients: A Preliminary Investigation

et al. 2015

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PurposeFew studies have addressed the specific behavioral changes associated with primary brain tumor (PBT). This paper will report on the frequency and demographic/clinical correlates of such behaviors, and the reliability of rating such behaviors among people with PBT, family informants, and clinicians. The association of behavioral changes and patient functional status will also be discussed.MethodsA total of 57 patients with 37 family informants were recruited from two large Australian metropolitan hospitals. Each completed three neuro-behavioral self-report measures; the Emotional and Social Dysfunction Questionnaire, the Frontal Systems Behavior Scale, and the Overt Behavior Scale. Patients also completed a depression symptom measure. Functional status was defined by clinician-rated Karnofsky performance status.ResultsPatients were on average 52 years old, a median of 4 months (range 1–82) post-diagnosis, with high grade (39%), low grade (22%), or benign tumors (39%). Patients reported frequency rates of 7–40% across various behavioral domains including anger, inappropriate behavior, apathy, inertia, and executive impairment. The presence of epileptic seizures was associated with significantly higher levels of behavioral changes. Notably, behavior did not correlate with tumor grade or treatment modality. There was moderate agreement between patients and relatives on the presence or absence of behavioral changes, and substantial agreement between relative and clinician ratings. Depressed patients did not generally report more changes than non-depressed patients. Increases in the relative and clinician-rated behavior scores were significantly correlated with decreasing functional status in the patient.ConclusionBehavioral changes were a common sequela of both benign and malignant PBT. Larger scale studies are required to confirm these results. The results suggest the importance of including behavior in brain cancer psychosocial assessments and the need to develop interventions to treat these patients and reduce the burden of care on families.

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