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Mental health problems, particularly psychotic symptoms, are associated with polycystic ovary syndrome (PCOS) which may be linked to oestrogen signalling cascade following a period of sustained high oestrogen and dysregulation of cortisol. This case report aims to demonstrate a potential link and improvement following the use of Metformin.

The paper describes a case of a female with intellectual disability who presents with psychosis coinciding with PCOS and the aetiology of this association.

The case highlights some key points and complexities encountered in diagnosing and managing an individual with mental and physical health issues and an underlay of family dynamics and insecure attachment. A treatment approach involving recommendations from and joint working between professional groups including endocrinology, is highlighted.

There are very few studies to date that link PCOS to psychosis and only a single case report describes the use of Metformin. In a patient presenting with psychosis and PCOS, the consideration of an association with hormonal changes should be made, especially in patients with changing severity of psychosis and poor response to psychiatric medication. A “multimodal” intervention package needs to be considered for optimum benefit.