Medical case narrative
Nineteen years as "schizophrenia" — a woman in Iran whose blood counts finally spoke
What happened
A woman in Iran (unnamed in the published report) had behavioural problems from age 9 and was expelled from school at 12. From age 17 she was treated for roughly 19 years across 11 psychiatric admissions, under successive diagnoses of major depressive episode with psychotic features, schizoaffective disorder, and finally schizophrenia. Her medications over the years included haloperidol, nortriptyline, risperidone, and clozapine, and electroconvulsive therapy was given in seven of the eleven admissions.
What it looked like
Seizures at age 12. Tremor and severe restlessness on her medications, read as drug side effects. Involuntary, jerky, dance-like limb movements, also read as side effects — and falls on the ward that nurses charted as "hysterical movements" and voluntary falling, which in retrospect were probably involuntary. Her blood counts fell on clozapine, and her platelet count dropped profoundly — recorded at 44,000, then 39,000, then 12,000 per mm³ — and it was that blood problem, at the very end, that triggered a haematology-to-hepatology referral chain.
What the labs found
She had been admitted after a suicide attempt (ingesting an alkali-based detergent, driven by commanding and persecutory hallucinations) and was in intensive care with chemical and aspiration burns and jerking of all four limbs when the Wilson's disease workup was finally done in 2013. Her serum ceruloplasmin was 0.164 g/L (reference 0.204–0.407), her serum copper 50 μg/dL (reference 70–153), her 24-hour urinary copper 240 μg/24h (reference up to 80), and Kayser-Fleischer rings — copper deposits visible in the eye — were present. The diagnosis was never confirmed by liver biopsy or genetic testing; it rests on the copper studies, the rings, and the clinical picture, and this entry says so.
What changed
Penicillamine, a copper-binding drug, was started once Wilson's disease was diagnosed. She died 11 days later, from the chemical burns and complications of the detergent ingestion. The reporting author describes this as the longest reported period — 19 years — of psychosis treated without the underlying cause being uncovered; that is the author's claim, printed here as his.
The test that told the story
Serum ceruloplasmin, serum and 24-hour urinary copper, and an eye examination for Kayser-Fleischer rings — set in motion by a platelet count nobody could ignore.
Sources: Elyasi F., "Misidentification of Wilson Disease as Schizophrenia (1998–2013)," Indian Journal of Psychological Medicine 2017 (primary case report, all values above); McCormick et al., PLOS Mental Health 2024 (a later review recounting the same patient).