Craniopharyngiomas are rare and benign intracranial tumours arising in the sellar region. Typically, patients with craniopharyngioma present with headaches, visual disturbances and endocrine deficits due to compression of adjacent proximal structures. Primary psychiatric clinical presentation has been rarely reported. We present the case of a 59-year-old female with craniopharyngioma with suprasellar extension into the third ventricle and a clinical picture dominated by behavioural changes. Due to mental disturbances, the patient was diagnosed and underwent initial surgical treatment in another medical facility. She was admitted to our Department due to a mental disorder relapse attributed to tumour regrowth. On admission, she was singing religious songs spontaneously or in response to questions, and neuropsychological examination revealed disturbances of memory, attention, executive functioning and decreased drive. The patient was scheduled for reoperation. Following subtotal resection, she was discharged home without psychiatric symptoms. Two years later, after initial improvement, the patient was readmitted with the same mental disorder and tumour regrowth. She underwent a second reoperation and was discharged with improved mental status. After a 2-month follow-up period, the patient’s family reported a complete resolution of behavioural disturbances. Based on the literature review and our observation, we assume that the psychiatric manifestation of craniopharyngioma might be associated with dysfunction of suprasellar structures, namely the hypothalamus, and in such cases, resection should be carried out to the maximum safe extent.