Rapid cycling bipolar affective disorder and recurrent strokes secondary to high blood homocysteine.

Introduction: The interface between psychiatric disorders and organicity has been a matter for contentious debate.

Aim: To report an interesting clinical case of moderate homocystinuria presenting with significant psychiatric and neurological deficits.

Method: A case report highlighting the impact of homocystinuria on producing intractable rapid cycling bipolar affective disorder.

Discussion: Homocystinuria is a frequently missed cause for treatment-resistant bipolar affective disorder.