PSYCH 034: The Neuropsychiatry of Brain Tumors

Brain tumours do not merely occupy space - they alter function. This chapter explores how focal growths within the brain can produce profound changes in cognition, behaviour, and personality, often before neurological signs become obvious.In this episode, we examine how tumour location, size, and rate of growth influence clinical presentation. Slowly growing lesions may allow partial adaptation, leading to subtle but progressive changes in personality, motivation, or judgement. More aggressive processes may produce rapid and dramatic shifts.We explore common neuropsychiatric manifestations, including apathy, disinhibition, mood disturbance, psychosis, and cognitive decline. Frontal and temporal lobe involvement is particularly associated with changes that can mimic primary psychiatric conditions.A key principle is mass effect - how pressure and displacement disrupt surrounding networks, not just the tissue directly involved. Symptoms often reflect these network-level disturbances rather than the lesion alone.This chapter reinforces an essential clinical vigilance: when behavioural or personality change is atypical, progressive, or resistant to treatment, an underlying structural cause must be considered.Brain tumours remind us that identity itself can be altered by physical processes - that the architecture of the brain shapes not only function, but who we appear to be.Key Takeaways* Brain tumours can present with neuropsychiatric symptoms before neurological signs.* Clinical features depend on tumour location, size, and growth rate.* Frontal and temporal lesions often produce behavioural and personality changes.* Symptoms may include apathy, disinhibition, mood disturbance, and psychosis.* Mass effect disrupts surrounding networks, not just local tissue.* Presentations can mimic primary psychiatric disorders.* Progressive or atypical symptoms should prompt investigation for structural causes. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit drmanaankarray.substack.com/subscribe