Mismanagement of Wilson′s disease as psychotic disorder

Abstract

Wilson's disease (WD) or hepatolenticular degeneration is an inherited neurodegenerative disorder of copper metabolism (autosomal recessive, chromosome13). Psychiatric disorders in WD include dementia, characterized by mental slowness, poor concentration, and memory impairment. Symptoms may progress rapidly, especially in younger patients, but are more often gradual in development with periods of remission and exacerbation. Delusional disorder and schizophrenia-like psychosis are rare forms of psychiatric presentation. In this report, the patient with WD presented by psychosis symptoms and treated mistaken as schizophrenia for almost ten years. Although he has treated with antipsychotics, he had periods of remissions and relapses and never was symptoms free. Since psychosis can be the manifestation of medical diseases such as WD, overall view of these patients is necessary and medical diseases should be considered as a differential diagnosis.

A Rare Case of First Attack Psychosis and Wilson Disease

“…But, in another study found that, the mean delay in correct diagnosis was 8 years (range 6 months to 20 years) (13). Similar cases were described in literature (11,14). …”

Atypical case of Wilson's disease with psychotic onset, low 24 hour urine copper and the absence of Kayser-Fleischer rings

“…The first peculiarity consists primarily of the dominant clinical psychiatric disorder, and because of that, the patient was diagnosed with a psychotic disorder, and for nearly 6 months was treated accordingly, with antipsyhotic therapy, and during that period he manifested theraporesistance. Similar cases were described elsewhere 18,19 .…”

Psychiatric comorbidity in Wilson’s disease

“…Findings from both early case reports (Dening, 1985;Jayaswal, Lal, Nepal, & Wig, 1984) and the Matarazzo, 2002;Shah & Vankar, 2003;Stiller, Kassubek, Sch€ onfeldt-Lecuona, & Connemann, 2002), mainly characterized by persecutory delusion. Hallucinations (mostly auditory) have been rarely reported and are typically associated with delusion of reference or persecution (Bidaki et al, 2012;Kontaxakis et al, 1988;Matarazzo, 2002). WD presentation with psychotic manifestation also encompassed the rare syndrome of catatonia in youth (Nayak et al, 2012;Sahoo, Avasthi, Sahoo, Modi, & Biswas, 2010) and even in paediatric age (Davis & Borde, 1993).…”