Chronic psychosis, delayed diagnosis and Wilson’s disease

Learning point for clinicians Wilson’s disease is a disorder of copper metabolism, primarily affecting the liver and brain. Atypical clinical presentation and delayed or misdiagnosis is not uncommon at initial stage. Primary care physician should be aware about varied manifestation of this potentially treatable disorder to avoid progression and disability. A 35 years male presented with 4 year history of predominant psychiatric symptoms in the form of impulsive behaviour initially and later developed delusion, visual hallucination and vivid dreams. He was being treated for schizophrenia with olanzapine, quetiapine and lorazepam without much avail. He was institutionalized for severe psychosis 3 months back and also developed tremor of hand and change in voice for which referred to neurology. He had past history of jaundice at age of 9 years which resolved with treatment. He was born of …