Identification and treatment of a pineal region tumor in an adolescent with prodromal psychotic symptoms.
An adolescent male patient originally presented to a prodromal clinical research program with severe obsessive-compulsive behaviors and subthreshold symptoms of psychosis, which eventually developed into first-rank psychotic symptoms. The patient was followed over a 2-year period. His symptoms did not respond to psychotherapy or pharmacotherapy. However, when a pineal region tumor was discovered and treated with chemotherapy and autologous stem cell rescue, both psychotic symptoms and psychosocial functioning reverted toward baseline. Although subcortical brain structures have been implicated in the pathophysiology of idiopathic psychosis, reports of psychiatric sequelae of treatment of subcortical tumors are rare. Etiological pathways that may have played a role in symptom development are of particular interest, as understanding these mechanisms may shed light on the pathophysiology of psychotic disorders more generally.
Mittal
Vijay A
VA
Department of Psychology, University of California Los Angeles, USA. vijay.mittal@colorado.edu
Karlsgodt
Katherine
K
Zinberg
Jamie
J
Cannon
Tyrone D
TD
Bearden
Carrie E
CE
D000293:Adolescent; D020144:Basal Ganglia Cerebrovascular Disease / Q000150:complications*; D057189:Checklist; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D019965:Neurocognitive Disorders / Q000150:complications / Q000175:diagnosis; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000209:etiology; D010871:Pinealoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000209:etiology*; D020521:Stroke / Q000150:complications; D011795:Surveys and Questionnaires
Psychiatry Res. 2009 Sep 30;169(2):107-12
19700201
Int J Neurosci. 1993 Jan;68(1-2):53-9
8063514
Schizophr Bull. 2003;29(4):703-15
14989408
J Neurosurg. 1997 Jul;87(1):103-5
9202274
Chang Gung Med J. 2006 Mar-Apr;29(2):198-202
16767969
Drug Saf. 1995 Feb;12(2):146-53
7766338
Mol Psychiatry. 2004 Oct;9(10):900-7
15241433
Schizophr Bull. 2008 Nov;34(6):1066-82
18791076
Psychiatr Q. 1999 Winter;70(4):273-87
10587984
Peptides. 1983 May-Jun;4(3):393-5
6634474
J Am Acad Child Adolesc Psychiatry. 2000 Jan;39(1):116-9
10638075
Front Neuroendocrinol. 2001 Jan;22(1):18-32
11141317
J Neuropsychiatry Clin Neurosci. 2001 Winter;13(1):61-9
11207331
Arch Gen Psychiatry. 2009 Jan;66(1):13-20
19124684
Eur Psychiatry. 1999 Jun;14(3):163-6
10572342
Neuroradiology. 2000 Jun;42(6):399-402
10929297
Am J Psychiatry. 2002 May;159(5):863-5
11986145
J Neurol Neurosurg Psychiatry. 1996 Nov;61(5):497-505
8937345
Arch Gen Psychiatry. 2008 Feb;65(2):165-71
18250254
Am J Psychiatry. 1998 Feb;155(2):264-71
9464208
Arch Dis Child. 1970 Feb;45(239):13-23
5440182
J Neuropsychiatry Clin Neurosci. 2007 Summer;19(3):293-7
17827414
Psychiatr Clin North Am. 1997 Dec;20(4):863-83
9443354
Schizophr Bull. 1990;16(4):653-62
2077642
J Am Acad Child Adolesc Psychiatry. 2001 Jan;40(1):6
11195564
Psychiatr Clin North Am. 1997 Dec;20(4):897-910
9443356