Introduction: The relationship between pre-existing psychiatric disease and intracranial tumors remains poorly understood. We examined rates of intracranial tumor diagnoses in patients with and without pre-existing comorbid psychiatric diagnoses to better understand this relationship.
Methods: We used a longitudinal version of the California Office of Statewide Health Planning and Development (OSHPD) database (1995-2010). We examined all patients ages 18-95 with confirmed hospital admissions between 2001 and 2004 (inclusive). Any patient admitted before 1997, or initially admitted with a psychiatric or intracranial tumor diagnosis were excluded. The primary outcome was the diagnosis of an intracranial tumor on any subsequent hospitalization within five years of the first admission of interest. Rates of tumor incidence were compared for patients with and without depression, anxiety, bipolar disorder, and schizophrenia. Analysis was carried out via Cox proportional hazard modeling adjusting for age, gender, race/ethnicity, and comorbidity burden on first admission of interest. Subset analyses were performed for different types of tumor
Results: The risk for diagnosis of an intracranial tumor within five years of the index admission, as determined by the hazard ratio, was highest for patients with a pre-existing diagnosis of bipolar disorder (HR = 1.54, 95%CI: 1.21-1.95 relative to no bipolar), followed by anxiety (HR = 1.45, 95%CI: 1.30-1.61 relative to no anxiety), and then depression (HR = 1.2, 95%CI: 1.12-1.30 relative to no depression). Specifically, this risk remained significant only for primary benign brain neoplasm or meningioma diagnosis amongst depressed patients, and meningioma alone amongst anxious, bipolar or schizophrenic patients.
Conclusions: Patients admitted with certain psychiatric diagnoses appear more likely to be readmitted within five years with a diagnosis of intracranial tumor. Whether such psychiatric conditions represent the first presentation of an intracranial tumor, or whether they pose an inherent risk to developing a tumor, deserves further study.
Patient Care: This research identifies a new set of risk factors (i.e. new-onset depression, anxiety, bipolar disorder, or schizophrenia) with which providers can better inform their own suspicions for intracranial neoplasms.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Identify those psychiatric diagnoses which carry a higher risk of intracranial tumor diagnosis, 2) Identify specifically which intracranial tumor diagnoses are more likely for these psychiatric patients, and 3) Discuss, in small groups, the potential theories as to why these particular patterns were observed.