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Doubts about diagnosis are frequent with isolated and foreign-born adolescents presenting acute psychiatric disorders, with the risk of diagnostic error – and inadequate care – as well of over-diagnosis of psychotic disorders as opposed to depression or post-traumatic syndrome. The course of the treatment of Lila, a sixteen year-old adolescent from Rwanda, illustrates the problematic of diagnostic errors or misdiagnosis which can be reduced by recourse to studies on diagnostic error and a transcultural approach to treatment.