Selenium and stereotypies in a mental health setting

A 24-year-old man was referred with involuntary stereotypies of movement and thinking, of which he seemed unaware. On admission, comprehensive physical screening proved negative except for lowered selenium concentrations. Neuropsychological assessment revealed changes in performance on tests of attention, non-verbal reasoning and executive function consistent with his stereotypies. A review of his movements characterised them as possibly being consistent with non-paroxysmal kinesigenic dyskinesia. A low dose of sulpiride led to improvements in engagement and insight accompanied by modest reductions in movements.