Brain tumors may present with multiple psychiatric symptoms (> 50%) and in 80% of the cases tumors are located in the frontal or limbic regions. Neuropsychiatric symptoms may be the first clinical indication of a brain tumor in 18% of the patients.

Brain metastatic tumors may be associated with a greater incidence of mental symptoms and are probably due to the tumors being scattered throughout the brain substance.

The authors report a case of a patient where the severe psychiatric symptoms, secondary to a metastatic brain tumor, were the initial presentation of a primary lung tumor.

A comprehensive review of the literature was conducted for reports of brain tumors and psychiatric symptoms, through PubMed, between Jan 1970 and Out 2010.

We also reviewed the patient medical records and computed tomography (CT) scans in detail.

Neither tumor location nor type is associated with specific psychiatric symptoms.

Mood symptoms may be a harbinger to an evolving brain tumor.

There is a statistically significant correlation of anorexia, without disturbance of body image perception, with hypothalamic tumors.

We conclude that brain tumors can be neurologically silent and only present with psychiatric symptoms. The diagnosis and treatment in the early phase of the disease are determinant for the survival and quality of life of patients with brain tumors.

Neuroimaging (CT and MRI scan) should be considered in patients with new-onset psychosis, recurrence of previously well-controlled psychiatric symptoms, occurrence of atypical symptoms and in patient's refractory to psychiatric treatment.