Fahr’s disease is a rare neurological disease that typically presents with neurological manifestations such as movement disorders. In a first recorded patient with Fahr’s disease in Bhutan, psychiatric diagnosis of bipolar affective disorder with current episode of severe depression was made, which is also a known manifestation of Fahr’s disease. Diagnosing a first case of Fahr’s disease is important for Bhutan because, though, it is a rare disease and it emphasizes the importance of recognizing other rare causes of psychiatric illness to tailor the treatment to the individual.

INTRODUCTIONNearly half of the 322 million people living with major depressive disorder (MDD) in the world are in the South-East Asia Region and Western Pacific Region 1 . With the increasing number of people suffering from depression, it will be a major contributor to the global disease burden by 2030 without further interventions 2 . In Bhutan, 11.69% of all psychiatric patients were diagnosed with MDD in 2017 3 .According to the World Health Organization (WHO) global report on Alcohol and Health 2018, the harmful use of alcohol resulted in an estimated 3 million deaths (5.3% of all deaths) globally in 2016 4 . Alcohol-related liver disease remains the top cause of mortality in Bhutan 2 . In 2017, 21.5% of all psychiatric patients had alcohol use disorder