Background: Multiple sclerosis (MS) is a neurological disorder that affects 2.5 million people worldwide. MS exemplifies the interface between neurology and psychiatry in a trajectory of neuro and psycho-pathologies that can conflate with the diagnosis of primary psychotic disorders. The protean nature of its neuropsychiatric manifestations could delay the diagnosis and management of such a challenging condition. Case Presentation: We present the case of a 52-year-old female who developed first episode of psychosis at the age of 48 years. There was no history of previous mental illness in either the patient, or in any family member. She had been formally diagnosed with a relapsing and remitting type of MS, at the age of 30 years. Six years later, she discontinued the recommended disease modifying therapy (DMT) which resulted in worsening of her MS and late onset schizophrenia-like symptoms. Her affect, however, was warm and interactive, and she exhibited a sense of general wellbeing and serenity, describing her psychosis as being “magical” despite the severity of her condition. Treatment of her psychiatric condition with depot psychotropic medication resulted in dramatic improvement of her psychosis with regain of insight, hence compliance on DMT and containment of her MS. Conclusion: Comorbid psychiatric and MS manifestations may be challenging regarding the diagnosis and management of either condition. Professionals in these fields, therefore, need to be aware of the relative high prevalence of mental health disorders in MS patients and that these may pre or post-date the diagnosis of MS, with the potential to confound the clinical picture.

Keywords: Multiple Sclerosis, Organic Psychosis, Schizophrenia-Like Symptoms.