169 Journal of Mood Disorders Volume: 7, Number: 3, 2017 - www.jmood.org Case Report DOI: 10.5455/jmood.20170820093356 A Rare Case of First Attack Psychosis and Wilson’s Disease Aslihan Okan Ibiloglu 1 , Abdullah Atli 1 , Mehmet Asoglu 2 , Mustafa Ozkan 1 1 Dicle University, School of Medicine, Department of Psychiatry, Diyarbakir - Turkey 2 Harran University School of Medicine, Department of Psychiatry, Sanliurfa - Turkey Corresponding Author: Aslihan Okan Ibiloglu, Dicle University, School of Medicine, Department of Psychiatry, Diyarbakir - Turkey E-mail address: aslihanokan@gmail.com Date of received: July 24, 2017 Date of acceptance: August 20, 2017 Declaration of interest: A.O.I., A.A., M.A., M.O.: The authors reported no conflicts of interest related to this article. ABSTRACT: A rare case of first attack psychosis and Wilson’s disease Wilson disease (WD) is an infrequent genetic disorder of copper metabolism (chromosome 13), with decreased transport of copper by hepatic lysosomes due to mutation in the Wilson disease protein (ATP7B) gene. Hence, accumulating copper is primarily affecting the liver, brain, cornea, and kidneys, after then leading to their symptomatic damages. During early ages, the patients are mostly presymptomatic. The worldwide prevalence was reported to be 1 in 30.000. Psychiatric symptoms are common with Wilson’s disease. Pychosis can be an initial manifestation and often leads to an inaccurate diagnosis. As is seen, clinical syndrome may be very complex. Therefore, detecting mental health disorders of secondary origin is very important for the mental health professionals. In conclusion, one must be aware of the possibility of an organic cause in patients who are admitted with psychiatric symptoms, for the first time. On the other hand, medical causes of psychiatric symptoms should always be considered. Here, we report on a case of psychotic disorder due to Wilson’s disease, presenting with psychotic symptoms and bizarre behaviour. Keywords: mental health disorders, psychosis, copper, atypical antipsychotic, wilson disease Journal of Mood Disorders (JMOOD) 2017;7(3):169-72 INTRODUCTION Wilson’s disease (WD) (also called hepatolenticular degeneration) is an infrequent autosomal recessive disorder of copper metabolism (chromosome 13) with decreased transport of copper by hepatic lysosomes due to mutation in the Wilson’ disease protein (ATP7B) gene. Accumulating copper is primarily affecting the liver, brain, cornea, and kidneys, after then leading to their symptomatic damages (1). But, during early ages, the patients are mostly presymptomatic. The worldwide prevalence was reported to be 1 in 30,000 (2). According to literature fndings, psychiatric symptoms associated with WD have been divided into four areas, including the personality changes, affective and psychotic disorders, and cognitive impairment (3,4). The most common psychiatric features were abnormal behavior and personality changes, although depression and impairment of cognitive function were also rated frequently. Compared to other psychiatric symptoms, psychosis is less commonly described in patients with WD (5). Therapeutic outcome of WD significantly depends upon its early recognition. Because, WD is one of the few curable disorders provided; it is diagnosed and treated early. Diagnosis of WD is often made clinically by the presence of Kayser-Fleischer (KF) rings, adjacent to cornea, low levels of serum ceruloplasmin (alpha-2 globulin, a serum glycoprotein), elevated concentrations of copper in the cerebrospinal fuid, and hyper intensities in the basal ganglia and thalamus of the brain (1,2). KF ring is present in 99% of neuropsychiatric patients (6). Here, we report a 42 years old woman presenting with bizarre behaviors and psychotic manifestations who was treated for Wilson’s disease, at the age of 33.