New-Onset Psychosis in an Adolescent with Wilson's Disease

[Author Affiliation]Svetlana Azova. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Timothy Rice. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Blanca Garcia-Delgar. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Barbara J. Coffey. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.Address correspondence to: Barbara J. Coffey, MD, MS, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, E-mail: Barbara.coffey@mssm.eduChief Complaint and Presenting ProblemE.was a 17-year-old adolescent boy with no psychiatric history except for a cannabis use disorder who was admitted to an inpatient psychiatric unit after 3 days of bizarre behavior.History of Present IllnessThe patient's mother reported that E. was a shy child who liked to stay by himself or hang out with his older brother. He had no history of behavioral or developmental problems that had required clinical attention, and he had done relatively well in school until a few months before his presentation. E. had been exposed to domestic violence in the home between his mother and his father. His mother separated from his father when E. was 6 years old, and his father had been inconsistently present in E.'s life since then. His mother reported that about a year ago, E. and his older brother got into a physical altercation with their father, and as a result, E. had had no contact with him until a few days before his presentation. By that time, his mother also noted that E. had begun smoking marijuana regularly, usually with his older brother. His mother reported that his use peaked about 5 months before this current presentation, and at that time, his school performance started to decline.Three months before presentation, his mother noticed an acute change in E.'s behavior and mood. He started talking back to others, thinking that people on the street were looking at him, and having frequent mood swings. His mother brought him to the emergency department where his symptoms were attributed to marijuana intoxication, and he was discharged home with a referral to a therapist. No medications were started. After that presentation, E. reportedly stopped smoking marijuana and his behavior returned to baseline, although he continued to struggle at school. He did not, however, adhere to the outpatient treatment plan nor arrange alternative care.A week before presentation, his mother noticed that E. had started smoking marijuana again (he came home with red eyes), was sleeping and eating less, and was engaging in new activities like yoga, which was out of character for him. He also started having idiosyncratic, bizarre conversations, and saying things such as "everybody is watching and talking about me" and "they know about my life." Two days before presentation, E. was on his way to summer school when he suddenly started crying, called his mother, and took the train back home. That night, E. started asking his mother whether his father was actually his real father. Due to this change in behavior, E. was referred back to the emergency department. His symptoms were once again attributed to marijuana, and he was discharged home. The following day, he was reported to be crying and saying that he wanted to see his father, which his mother did not allow; his mother instead called his father and told him to come and see E. The next day, E. met with his father and said that he forgave him for everything. His father noted a change in E.'s behavior; he had to return him to his mother after E. unexpectedly ran out of the house. After the encounter with his father, E. again left the house and was found in the middle of the night by his older brother, lying on a bench in the park saying, "I belong on the streets," "my bed is here," and "it's my life. …