Lucy is a 34-year old single mother who has recently been diagnosed with a cranial

tumour in the right frontal lobe. The diagnosis explains her symptoms of persistent
and worsening headache over the last four weeks, which have led her to resign from
work and rely more on her mother for support and care. Lucy has also experienced
symptoms of increased intracranial pressure, such as nausea, vomiting, and mild
photophobia. Hence, it is likely that the tumour is a space-occupying lesion, which
is exerting the oedema effect and causing the symptoms that Lucy is experiencing.
Taking her age and sex into consideration, the lesion is most likely to be a
primary lesion, single and benign in nature. In addition, given that Lucy's father
died 15 years ago of stroke related causes, her mother and her sister both have
cardiovascular illness, and Lucy has HERNS syndrome, there is a high probability
that the tumour has a vascular cause.
Lucy has become depressed and withdrawn since finding out that she has a brain
tumour. In particular, she is very anxious about the possibility that the biopsy
results will show that the tumour is cancerous. Although symptoms of depression and
anxiety are not uncommon in patients threatened by a diagnosis of cancer, Lucy has
a history of feeling melancholy and, significantly, developed postnatal depression
following the birth of her son five years ago. Lucy's response to her current
illness needs to be understood in this context, as it will help to assess how well
she will cope with the forthcoming diagnosis and future management of her illness.
Upon the mental state examination, Lucy exhibited sullen appearance and limited
facial expression. Although articulate, she spoke slowly and softly throughout the
interview. Clearly, Lucy has a depressed affect. Her history of childhood
depression in conjunction with her recent history of poor appetite, sleep
disturbance, energy loss, reduced concentration and feelings of guilt indicate that
Lucy is prone to developing a major depressive disorder in response to her current
medical condition.
From the information gathered in the history and examination, the following
differential diagnosis can be posited:
1) Major depressive disorder
Lucy's unhappy childhood and psychiatric history of depression support this
diagnosis. In addition, she meets at least five of the DMS-IV criteria on mental
state examination.
2) Biological disorder
The tumour in Lucy's right frontal fossa might affect functions of the frontal
lobe, which control thought and personality. Consequently, Lucy's personality
traits may be enhanced by such a biological disturbance, making her more prone to
stress and depression.
3) Anxiety
Lucy's sudden confinement in hospital, diminished ability to perform daily
activities, and concerns about her family and health, predispose her to
experiencing anxiety, a potential trigger of depression.