the initial manifestations are neurologic in 40% of patients , hepatic in 40% and psychiatric in 15% of patients . wd is an autosomal recessive condition characterized by inability of the liver to transport and store normally absorbed dietary copper , resulting in abnormal deposition of copper in the basal ganglia , eyes , liver and other tissues . in 1912 , kinnier wilson published a description of 12 patients who presented with extrapyramidal motor disease and , on autopsy , demonstrated softening of the lenticular nucleus and cirrhosis of the liver . he further noted that these patients exhibited  emotionalism  , and 2 of his 12 patients presented with schizophrenic - like psychoses . scheinberg and sternlieb wrote that 1025% of patients with wd initially present with psychiatric symptoms . psychiatric symptoms in wd may range from major depression , mania , and anti - social behavior to psychosis . g. d. , a 32-year - old unmarried gentleman born of non - consanguineous parents , presented with personality change and behavioral disturbances since the last 6 months . the behavioral disturbances were in the form of emotional liability , aggressiveness and disinhibition and delusions . he had past history of jaundice at 18 years of age which resolved in 3 months . physical examination at the time of the admission revealed a kf ring obvious on naked eye examination and risus sardonicus . higher mental function examination revealed impaired attention span  7 days of week forward and 2 days of a week backward , and he was able to comprehend two - stage axial commands . he lost three points in orientation to time , two points in orientation to place , five points for calculation , one point in construction and one point in recall . he had impaired abstract thinking and could not explain the meaning of a given proverb . complete blood count ( cbc ) was normal ; total bilirubin : 0.6 mg% ; direct bilirubin : 0.15 mg / dl ; total protein : 8.2 g / dl ; albumin : 4.8 g / dl ; globulin : 3.4 g / dl ; serum glutamic oxaloacetic transaminase ( sgot ) : 35 iu ; serum glutamic pyruvic transaminase ( sgpt ) : 22 iu ; alkaline phosphatase : 84 the 24-hour urinary copper was significantly elevated , i.e. 635.52 g / day ( normal 32 - 64 g / day ) . usg abdomen revealed liver parenchymal disease with minimal free fluid in the abdomen along with splenomegaly . for the severe agitation and restlessness , he was given injection haloperidol 5 mg i m in bid doses for 2 days haloperidol was replaced with quetiapine 25 mg tablet which was increased to bid over the next 2 weeks . after 2 weeks of inpatient treatment with antipsychotics and sedatives , his behavior was controlled . the patient was started on penicillamine 250 mg daily which was gradually increased to 250 mg five times a day supplemented with pyridoxine 40 mg daily . wd is an autosomal recessive disease characterized by inability of the liver to transport and store normally absorbed dietary copper , resulting in abnormal deposition of copper in the basal ganglia , eyes , liver and other tissues . he had emotional lability , disinhibition and was severely agitated , restless with delusional thoughts . since the psychiatric symptoms in wd are generally mild , patients may not present with these symptoms . of the 108 patients , only 9 ( 8.3% ) manifested severe psychiatric symptoms that required admission . among these patients , only one patient developed bipolar disorder that began some months before the onset of neurologic disorder . our patient presented with severe neuropsychiatric symptoms and had tremors on examination which were present since 5 years . a high degree of suspicion and early detection of wd is critical because early initiation of chelation therapy can prevent a catastrophic outcome .