Presenting and therapy-related psychiatric manifestations of metastatic and primary brain tumors: A meta-analysis and systematic review.

Abstract

e14080 Background: Brain tumors range widely in histopathological characteristics and clinical severity. Presenting clinical cues of brain tumors range from focal neurological deficits to more insidious psychiatric symptoms. The purpose of this study is to describe the landscape of psychiatric manifestations of brain tumors. Methods: Datasets including Pubmed, MEDLINE, Scopus, Embase, PsychINFO, and Web of Science were queried for case reports between 1965-2025 using key terms for a variety of brain cancers and psychiatric symptomatology. Only case reports with adult patients with image and biopsy confirmed brain tumors with psychiatric symptoms were included. Duplicate deletion and abstract and full text screening was conducted with Rayyan.AI. Results: 16,480 total papers were extracted. 131 cases were included and 70 clinical studies. The median age of patients reported was 48 [IQR 36–59] with the majority males (53.4%). Mood (48.1%) and psychotic (40.5%) presentations were most common, with resolution commonly reported (58.8%). The majority of tumors were astrocytomas (30.5%) and meningiomas (25.2%) in the temporal lobe (26.0%). In multinomial regression (N=125), male sex was associated with psychotic vs mood presentation (aRRR 3.02, 95% CI 1.24–7.32; p=0.0146), and left laterality reduced odds of other vs mood symptoms (aRRR 0.06, 95% CI 0.01–0.70; p=0.0247). Surgery predicted resolution (Yes vs No: aOR 6.59, 95% CI 1.18–36.73; p=0.0314) and remained significant in sensitivity analysis (aOR 6.65; p=0.0018); AED/ECT was also associated (aOR 4.52; p=0.0392). Conclusions: Psychiatric manifestations of intracranial tumors were the most often reported in astrocytomas and meningiomas with laterality playing an important role in the type of psychiatric disorder. As other factors did not play a large role, psychiatric manifestations of tumors may be more related to the tumor-neural compartment interaction than mass effect. Moreover, there is a need for increased research in the psychiatric manifestation of metastatic cancers. Adjusted predictors of symptom resolution in psychiatric presentations of brain tumors. Predictor Resolution of Symptom Yes vs No (N=91) aOR (95% CI) p Sensitivity: Resolution Yes vs (No+Partial) (N=103) aOR (95% CI) p Tumor treatment: Surgery vs Non-surgery 6.59 (1.18–36.73) 0.0314 6.65 (2.02–21.90) 0.0018 Symptom mgmt: Psych meds vs None/Other 6.41 (0.59–69.87) 0.1272 1.15 (0.32–4.19) 0.8316 Symptom mgmt: AED/ECT vs None/Other 4.91 (0.87–27.80) 0.0720 4.52 (1.08–18.96) 0.0392 Tumor type: Meningioma vs Astrocytoma 8.79 (0.38–201.65) 0.1738 12.44 (0.97–159.41) 0.0527 Age (per 1-year increase) 0.98 (0.94–1.02) 0.3715 0.99 (0.96–1.02) 0.5608 Psychiatry involved: Yes vs No/NS 1.20 (0.39–3.67) 0.7548 0.59 (0.19–1.86) 0.3681 MRI used: Yes vs No/NS 0.72 (0.13–3.97) 0.7086 0.49 (0.09–2.76) 0.4203