Psychiatric disturbances as a first clinical symptom of Wilson’s disease – case report.

Abstract

WD should be always considered in differential diagnosis of psychiatric disorders in young patients, especially if they present additional extrapyramidal or hepatic symptoms. It is also extremely important to remain cautious when drugs with high affinity to dopamine D2 receptors need to be initiated in patients already diagnosed with WD, as they may result in severe and often irreversible neurological complications.

Psychiatric manifestations in Wilson’s disease: possibilities and difficulties for treatment

“…The psychiatric symptoms of WD are highly prevalent and among the biggest challenges in WD management for several reasons. 4 , 27 , 55 , 57 , 67 , 68 First, because the early diagnosis of WD in patients with initial psychiatric symptoms is difficult; 12 , 13 , 70 , 75 and second, because there are no guidelines for the treatment of psychiatric symptoms in WD that take the specificity of this disorder into account. 1 …”

“…In summary, there is a wide spectrum of psychiatric symptoms observed in WD, leading to the conclusion that WD should be included in differential diagnosis, especially in young adults presenting with the first episode of psychiatric symptoms, 12 and WD should be suspected in all young adult psychiatric patients presenting with extrapyramidal and/or hepatic symptoms. 12 , 13 , 62 …”

“… 1 , 11 However, some WD patients require treatment with additional drugs that target the problems that can arise over the course of WD, such as symptoms of liver failure (portal hypertension, coagulopathy, pancytopenia), skin changes, neurological symptoms including dysphagia, tremor, dystonia and sialorrhea, and psychiatric symptoms. 1 , 12 – 14 While treatment of the hepatic and neurological symptoms of WD has been established and there are published international recommendations for the general management of WD, liver failure, and transplantation, there are currently no recommendations for the management of psychiatric symptoms associated with WD. 14 , 15 …”

Psychiatric comorbidity in Wilson’s disease

“…Psychiatric symptoms/disorder Occurrence/topic Ala et al (2005) depression onset Ara ujo-de-Freitas et al 2014depression onset Aravind et al (2009) mania onset Bidaki et al (2012) psychosis onset Carr and McDonnell (1986) adjustment disorder onset Chakraborty et al (2015) depression onset Chan et al (2005) depression/personality disorder/suicide attempt onset Chand and Murthy (2006) mania onset Crumley (1990) depression onset Davis and Borde (1993) catatonia onset Grover et al 2014psychosis treatment Juki c et al 2006psychosis onset Keller et al (1999) mania onset Kenar and Menteseoglu (2014) mania in course Kontaxakis et al (1988) psychosis onset Krishnakumar and Riyaz (2005) depression onset Krsti c et al 2014psychosis onset Kulaksizoglu and Polat (2003) mania treatment Kumawat et al (2008) obsessive-compulsive disorder onset Leggio et al (2007) anxiety in course Lin et al (2006) Attention Deficit Hyperactivity Disorder (ADHD) onset Lingam et al (1987) conduct disorder onset Litwin, Chabik, and Członkowska (2013) depression treatment Litwin et al (2016) mania treatment Loganathan et al (2008) mania in course Machado et al (2008) mania onset Matarazzo (2002) psychosis onset McDonald and Lake (1995) psychosis treatment McDonnell and Esmonde (1999) bipolar disorder onset Millard et al (2015) irritability/suicidal ideation onset Mitra et al (2014) mania in course Modai et al (1985) schizophrenia-like psychosis treatment M€ uller (1999) psychosis/change in mood/aggressive behaviour/suicide attempt onset Nayak et al 2012catatonia onset Nazariah et al 2011mania onset Negro and Louz a Neto (1995) depr...…”

“…Moreover, lithium might worsen tremor and impair cognition, and copper chelation therapy has only been shown to reduce manic symptoms (Loganathan et al, 2008;Machado et al, 2008;Mitra et al, 2014). Some authors reported a good response of manic symptoms with atypical antipsychotics, such as olanzapine (Litwin, Dzie_ zyc, Karli nski, Szafra nski, & Członkowska, 2016), and quetiapine (Kulaksizoglu & Polat, 2003;Zimbrean & Schilsky, 2015). Traditional neuroleptics, such as haloperidol, could determine the occurrence of extrapyramidal symptoms in individuals both with BD (Varghese et al, 2008) and with psychotic symptoms in WD (Nayak et al, 2012).…”