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INTRODUCTION: Chromosomal aberrations, with or without congenital physical abnormalities, have been frequently found associated with neuropsychiatric disorders, including mental retardation, psychosis, autism, and criminal behaviour. The meaning of the association frequently remains unclear. However, consistent findings of association between specific chromosomal abnormalities and clinical phenotype may provide evidence of a causal relationship and shed light on the pathogenesis of obscure disorders. CASE-REPORT: Here, we present the case of a 28 year-old, Caucasian male affected by pervasive developmental disorder, associated with chromosomal translocation 46, XY, t (X; 4) (p11; q13), and abnormal facial features. A few days after birth, the patient was taken away from his parents and adopted for unknown reasons. No information is available about his biological relatives. Mild delay in the development of spoken language was reported. Since early childhood, the patient's behaviour was characterized by troublesome relationship with his parents and his fellows, and persistent violation of norms and rules at home and at school. Consequently, social and school functioning was poor. When he was eight, verbal and motor stereotypy appeared for the first time. As an adolescent, he was more and more aggressive. He exhibited countless episodes of rage and verbal and physical aggressiveness. After he had completed secondary school, his way of life was chaotic. He got into the habit of staying away from home, sleeping in the day and vagabonding at night. He began to abuse alcohol. Grandiosity and persecutory delusions became evident. He claimed to hate the Vatican, the Pope, and the Polish people and to be the Devil, the Antichrist. He feared that his food was poisoned by his mother and refused to eat at home any more. He loved to remain in a cage with two wild dogs, accumulating and keeping bottles full of his urine. He often engaged in violent fights in the street with tramps and foreigners. Finally, he was involuntary admitted to a psychiatric intensive care unit. He was hostile, uncooperative, and violent. Magnetic resonance imaging of brain was normal, Wechsler Adult Intelligence Scale IQ score was 96 (total), 108 (verbal), 80 (non verbal), and Standard Progressive Matrices score was 44/60, chromosomal examination [banding R (RBG)] revealed an apparently balanced translocation 46, XY, t (X; 4) (p11; q13). The patient was treated with risperidone (8 mg/day) and valproate (1500-2000 mg/day) with improvement. Psychotic symptoms, hostility and violence vanished. Amazingly, his behaviour and attitude became normal. Very early onset of symptoms, absence of negative signs, and dysmorphic features suggesting an underlying medical disease do not support the diagnosis of schizophrenia. DISCUSSION: The diagnosis of pervasive developmental disorder, not otherwise specified, could be made, considering the delay in the development of spoken language, the large discordance between verbal and non verbal WAIS IQ score, the presence of stereotypy, abnormal facial features, and motor clumsiness. The late onset of symptoms precludes the diagnosis of autism, while the delay in language does not permit the diagnosis of Asperger's disorder. The lack of information on his biological relatives did not permit us to assess the presence of genetic, physical or mental abnormalities in his family. Therefore, the causal relationship between the chromosomal translocation and the psychiatric disorder is uncertain in this patient. Similar genetic abnormalities found in patients affected by neuropsychiatric disorders could confirm an etiological link.