The Role of Neuropsychiatry in Meningioma Care: A New Perspective David Silbersweig M.D. Chairman, Department of Psychiatry Chairman, Institute for the Neurosciences Brigham and Women’s Hospital Stanley Cobb Professor of Psychiatry Harvard Medical School
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The Role of Neuropsychiatry in Meningioma Care: A New Perspective
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The Role of Neuropsychiatry in Meningioma Care: A New Perspective
David Silbersweig M.D.Chairman, Department of Psychiatry
Chairman, Institute for the NeurosciencesBrigham and Women’s Hospital
Stanley Cobb Professor of PsychiatryHarvard Medical School
Case Presentation• I present to you a case of woman in her 60s
who had a life long history of depression treated with antidepressants and psychotherapy
• In 2002, her depression significantly worsened prompting her first suicide attempt
• Her psychiatrist requested a neurologic consultation and brain MRI to evaluate for neurologic causes of her mood decompensation Newsweek, 2007
Case Presentation• A small, 1cm meniongioma was detected but
was thought to be asymptomatic and of little initial concern
• Unfortunately, her condition further declined including two additional suicide attempts
• By 2006, she made her fourth suicide attempt and was now additionally experiencing weakness, memory trouble and language disabilities and continued depression
Newsweek, 2007
Case Presentation• There was now repeated concern for neurologic
disease and a repeat MRI was obtained revealing a meningioma that had grown 6 times larger
• Patient had surgery to remove her tumor
• Her neurosurgeon wrote in follow-up: she has gone "from being completely unresponsive to a walking, talking, normal human being again."
Newsweek, 2007
Case Presentation
Newsweek, 2007
“I celebrated that the tumor causeddepression was gone”
Lessons Learned
• Neurologic disease can present with psychiatric symptoms
• Psychiatric symptoms can sometimes be the first manifestation of neurologic disease including meningiomas
• Neuropsychiatry can help provide a complete picture of mind-brain through an integrated understanding of Neurologic and Psychiatric disease
neuropsychology, neuropathology, social work, rehab medicine/occupational therapy
– State-of-the-art, multi-faceted treatment plans• Medical, surgical, psychological, social
– Access to new therapeutic trials
• Unique scientific and educational brain-mind programs, led by world leading physician-scientists, at the interface of traditional academic medical fields