Progressive hepatolenticular degeneration or Wilson's disease is a rare autosomal recessive genetic disorder of copper metabolism, which is characterised of hepatic and neurological disorders due to the accumulation of copper in organs such as the liver or the basal ganglia. The manifestations of Wilson's disease are multiple and sometimes insidious, which makes the diagnosis very complicated.

A clinical case was followed and reviewed to illustrate the psychiatric symptoms in Wilson's disease.

A 23-year-old male came to the emergency room presenting insomnia, logorrhea, euphoria, irritability and a slight tremor in the upper limbs. Symptoms started two weeks before. The previous year, he was diagnosed of bipolar disorder after a manic episode which required inpatient treatment with risperidone and lithium. During the actual hospitalization, the tremor increased progressively and affected all four limbs and his head. He was then examined by neurology and an ophthalmology service, who ordered some specific complementary exams. Low levels of ceruloplasmin and serum copper and high levels of urinary copper confirmed the diagnosis of Wilson's disease. Treatment with copper chelants was introduced and the psychiatric symptoms and the analyses got better in several weeks.

Even a typical presentation of a psychiatric syndrome can be part of the spectrum of an organic illness. So an organic etiology should always be considered in the differential diagnosis, as sometimes it is possible to be treated.