A female patient with depression and conversion disorder following brain tumor surgery

To the Editor

Brain tumors can cause serious disturbances in the central nervous system (CNS). They may be revealed by certain psychiatric disorders before any neurological changes are noticed (Kaleita et al., 2004). Oligodendroglioma is a type of brain tumor that develops from glial cells known as oligodendrocytes, which can cause psychiatric disorders. This type of tumor grows slowly and therefore any neurological or psychiatric symptoms can take a long time to develop (Michotte et al., 2009). Anxiety and depression are often observed in patients diagnosed with a brain tumor. The tumor may cause changes in mood and personality or cause problems with coordination and speech (Bunevicius et al., 2008).

A 28-year-old right-handed patient was admitted to the psychiatric ward due to low mood, thoughts of worthlessness and resignation, apathy and anhedonia. The patient was diagnosed with mild depression and prescribed sertraline 50 mg/day. In addition, the patient complained of symptoms including conversion disturbances such as a sense of formication on the upper extremities and face, and also torticollis.

Two years before admission, the patient underwent surgery for a brain tumor in the left occipital region (oligodenroglioma II). During admission the patient sometimes withdrew from verbal contact with the doctor. Additionally, the patient had a difficult family situation with lack of support from her husband, which demotivated her from commencing psychotherapy. The patient underwent neurosurgery for a second time due to proliferation of the oligodendritic cells and remained under continuous oncological care.

Her symptoms of depression intensified and the diagnosis of severe depression was made. Sertraline was therefore titrated up to 100 mg/day. Valproic acid 100 mg/day and trazodone 50 mg/day were also added. After 8 weeks of treatment the symptoms of depression and the conversion disturbances decreased and her mental condition improved. The patient underwent neuropsychological tests, including Addenbrooke’s Cognitive Examination (ACE test), the Trail Making Test (TMT), the Bourdon test, the Rey–Osterrieth Complex Figure Test (ROCF) and the Benton Visual Retention Test (BVRT). The Minnesota Multiphasic Personality Inventory-1 (MMPI-1) test was also performed.

Personality examination of the patient revealed a tendency towards a defensive attitude and dissimulation. During examination an elevated neurotic triad was noted, which suggested a clear component of depressive and anxiety symptoms. On the basis of the neuropsychological tests, a serious deficit in recent visual memory was recorded. Attention span was also below the normal range. The Benton test revealed errors, indicating the process of organic changes in the central nervous system of the patient. The psychological tests clearly demonstrated large functional difficulties in the occipital region of the CNS. As a result, the patient started supportive therapy with elements of behavioral therapy, which were effective.

This case report reveals that a diagnosis of brain tumor can be so stressful for the patient that it may cause depression. Unrecognized mood disorders in patients diagnosed with a brain tumor may contribute to the development of severe depression, as in this case, and may delay oncological treatment. Mood disorders and brain tumors diagnosed too late may compromise the patient’s motivation for psychotherapy. Pharmacotherapy and psychotherapy can improve mental health and return motivation to continue oncological treatment (Espirito-Santo and Pio-Abreu 2009; Porter et al., 2007).