&lt;i&gt;Wilson's disease&lt;/i&gt; presenting as isolated obsessive-compulsive disorder

Kumawat, Banshi Lal; Sharma, C. M.; Tripathi, Gautam; Ralot, Tarun Kumar; Dixit, Shailesh

doi:10.4103/0019-5359.37047

Cited by 29 publications

(17 citation statements)

References 7 publications

(10 reference statements)

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“…[27] Psychiatric presentation, mostly case reports, of WD has also been recognized. [38][39][40] In a series of 350 patients with WD, in 15 patients psychiatric manifestations were the predominant symptom at the time of medical consultation. The psychiatric diagnosis was bipolar affective disorder, schizophrenia and psychosis with cognitive decline.…”

Section: Geneticsmentioning

confidence: 99%

Wilson′s disease: An Indian perspective

2009

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Wilson's disease (WD) is an autosomal recessive disease involving a defect of copper transport by the hepatic lysosomes. It leads to excess copper deposition in the liver, the brain, the kidneys and the skeletal system, affecting most commonly children or young adults and running an invariably fatal course if not adequately treated by de-coppering therapy. The last century has witnessed several changes, notable among these are: Increased awareness, improved diagnostic facilities leading to earlier recognition even in the pre-symptomatic phase, clear distinction from its mimics, aggressive therapeutic approaches owing to availability of effective treatment and an overall reduction in the morbidity and mortality. It is widely acknowledged that the disease is not as rare as once believed. Sir SAK Wilson published his landmark article in 1912, but it was only in 1968 that the first patient of WD was reported from our country. Publications from India on WD have focused on phenotypic characterization, documentations of lesser recognized aspects of the disease e.g. seizures, behavior abnormality, speech and cognitive impairment, sub-clinical affection of visual pathway, heart and autonomic function and pre-symptomatic detection. Attempts have been made to understand the clinical heterogeneity of the disease through identification of biochemical and immunological markers, magnetic resonance imaging, neuropathological study and genetic analysis for novel and/or known mutations. Assessment of impairment and severity and effect of various therapeutic interventions namely zinc sulphate on the long-term outcome and quality of life have also been studied. Nevertheless, clinicians often face difficulties in long-term care of these patients. Diagnostic errors leading to delay in diagnosis and initiation of treatment are common, even in patients with positive family history. There is no consensus regarding therapeutic protocols since the use of penicillamine, once a 'gold standard' for treatment, has been debated by experts. Mortality and morbidity of this potentially treatable disease and nonavailability of medications to the poor patients remain a major area of concern.

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Section: Geneticsmentioning

confidence: 99%

Wilson′s disease: An Indian perspective

2009

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“…Wilson's disease may mimic an OCD with contamination obsessions and washing compulsion together with feet tapping [13]. Ward atmosphere may depend too much on the purported effect of medication.…”

Section: Discussionmentioning

confidence: 99%

Obsessive-compulsive disorder in disguise—Case report

Berg¹,

Grimeland²

2012

OJPsych

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Obsessive-compulsive disorder (OCD) may mimic other minor and major psychiatric disorders or symptoms. Psychomotor disturbances may also be seen in OCD. Symptoms and complaints could be misinterpreted. Differential diagnostic assessments would be difficult either if the person has OCD or another diagnostic entity with OCD related symptoms. If clinicians in residential or outpatient settings do not realize this, the patients may suffer from inadvertent pharmacological treatment efforts, to no avail. A representative case of the former is presented. Withdrawal of all psychotropic medications cold turkey did not increase symptom load during the following weeks, indicating little benefit from medications. Because of continued complaints from the patient, psychotropic medications were gradually reintroduced, without any improvement. OCD patients may not be helped by extensive use of psychotropics and doctors responsible for them should employ other methods of reducing OCD symptoms than lumping together diverse psychotropics. There is evidence for the value of intensive cognitive behaviour therapy, but also for addressing the social conditions of the patients.

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“…The psychiatric presentations associated with adult onset Wilson's disease include a wide range of psychiatric symptoms3 4: suicidality,5 affective disorder spectrum,6 bipolar affective disorder,7 8 depression,1 9–11 psychosis,1 10–14 anxiety related disorders,10 obsessive compulsive disorder,15 personality changes16 and cognitive deficits 17 18…”

Section: Discussionmentioning

confidence: 99%

Complex psychiatric presentation in adolescent onset Wilson's disease

Woerwag‐Mehta¹,

Hindley

Hedderly

et al. 2011

Case Reports

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A previously healthy 15-year-old boy presented with a 2-week history of acute tremor in his hands, fasciculation of his tongue and a sensation that his mind was going blank. Physical examination and investigations confirmed a diagnosis of Wilson's disease and chelating treatment was started. As his neurological symptoms and liver function started to improve he developed tearfulness symptoms of depression and intense doubt about everything he thought and said. He was diagnosed with a moderate depressive episode and obsessive compulsive disorder as a result of Wilson's disease and started on citalopram. After an initial period of improvement with citalopram, his symptoms changed and he appeared irritable, restless, impulsive, disinhibited and was unable to sleep. Bipolar affective disorder was diagnosed and treatment changed to lithium carbonate and olanzepine, which led to a gradual mood stabilisation and successful recovery.

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<i>Wilson's disease</i> presenting as isolated obsessive-compulsive disorder

Abstract: ABSTRACT

Cited by 29 publications

References 7 publications

Wilson′s disease: An Indian perspective

Wilson′s disease: An Indian perspective

Obsessive-compulsive disorder in disguise—Case report

Complex psychiatric presentation in adolescent onset Wilson's disease

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