Delirium and psychoses

The management of patients with brain and spine tumors can be broadly divided into tumor-directed therapies and management of symptoms related to the tumor and its treatment, also referred to as supportive care. Since many tumors are incurable and result in a lot of distress and major impact on patient quality of life, symptom management has acquired immense importance in the neuro-oncology care philosophy. Among multiple issues that are challenging for brain cancer patients, delirium and psychosis require special effort and attention. Delirium and psychosis impact the quality of life of the patient, but also can impact caregivers’ burn out and cancer treatment plans. Some of the most challenging aspects of brain tumor patient care lie with the recognition and treatment of psychiatric disorders associated with the tumor diagnosis. Delirium and psychosis may be the most difficult of these disorders to manage. This chapter's focus is mainly on clinical manifestations, diagnosis, and causes of delirium and psychosis that affects patients with brain and spine tumors and explores the management of these disorders. Special attention is given to certain aspects of psychiatric care that arise in patients whose life expectancy is 6 months or less.