Bipolar disorders and Wilson’s disease

Abstract

BackgroundThe aim of this study was to determine the risk for Bipolar Disorder (BD) in Wilson’s disease (WD) and to measure the impaired Quality of Life (QL) in BD with WD using standardized psychiatric diagnostic tools and a case control design.MethodsThis was a case control study. The cases were 23 consecutive patients with WD treated at the University Hospital in Cagliari, Italy, and the controls were 92 sex- and age-matched subjects with no diagnosis of WD who were randomly selected from a database used previously for an epidemiological study. Psychiatric diagnoses according to DSM-IV criteria were determined by physicians using structured interview tools (ANTAS-SCID). QL was measured by means of SF-12.ResultsCompared to controls, WD patients had lower scores on the SF-12 and higher lifetime prevalence of DSM-IV major depressive disorders (OR = 5.7, 95% CI 2.4–17.3) and bipolar disorders (OR = 12.9, 95% CI 3.6–46.3). BD was associated with lower SF-12 in WD patients.ConclusionsThis study was the first to show an association between BD and WD using standardized diagnostic tools and a case control design. Reports in the literature about increased schizophrenia-like psychosis in WD and a lack of association with bipolar disorders may thus have been based on a more inclusive diagnosis of schizophrenia in the past. Our findings may explain the frequent reports of loss of emotional control, hyperactivity, loss of sexual inhibition, and irritability in WD patients. This study was limited by a small sample size.

Potential use of lurasidone for the treatment of bipolar psychosis

“…Neurological diseases that require pathogenetic mechanisms with impaired oxidation in the brain, such as Wilson's disease, multiple sclerosis and systemic sclerosis, were found to be strongly associated with BD [37][38][39][40].…”

Elementos traza y trastorno afectivo bipolar

“…En pacientes con enfermedad de Wilson se describen fases maniacas y depresivas, catatonia, agitación y agresión como manifestaciones iniciales de la enfermedad, que sugieren una asociación entre estos cambios de comportamiento y cantidades elevadas de cobre; pero no se cuenta con evidencia sólida que demuestre esta asociación [26].…”

“…Desde 1990, Goodwin y Jamison [26] han sugerido hipótesis acerca de las anormalidades en la excitabilidad o en la conductancia iónica de la membrana celular en pacientes con TAB. En pacientes con trastornos afectivos se plantea una posible disfunción de membrana celular neuronal como condicionante en el intercambio de las concentraciones de litio; sin embargo, concentraciones terapéuticas de litio interfieren con la transducción de señales intracelulares neuronales.…”

“…Desde 1995 se han desarrollado y validado métodos analíticos para determinar la concentración de litio en fluidos biológicos. Daffon et al [26] midieron concentraciones de litio plasmático en orina de pacientes con TAB sin encontrar diferencias significativas al compararlos con los niveles documentados en el grupo control. Describieron cantidades aumentadas de litio en pacientes con alto consumo de medicamentos antiinflamatorios, frutas cítricas, cerveza y una niveles bajos en pacientes que consumían antidepresivos serotoninérgicos [22].…”

Homogeneous magnetic resonance imaging of brain abnormalities in bipolar spectrum disorders comorbid with Wilson's disease

“…Today, it is known that a high frequency of a large spectrum of psychiatric symptoms characterizes WD, although a specific association between bipolar spectrum disorders (BDs) and WD was recently found [6]. Patients with WD comorbid with BDs are also characterized by a worsening quality of life compared with those without BDs and even those with major depressive disorder (MDD) [7].…”