Psychiatric disturbances as a first clinical symptom of Wilson's disease - case report.

Abstract

Wilson's disease (WD) is an inherited disorder of copper metabolism with wide spectrum of clinical symptoms, mainly hepatic or neurological. Psychiatric disorders occur less frequently and are not pathognomonic for WD. However, in almost 20% of cases they are in fact the first clinical manifestation of WD. The aim of this paper is to emphasise the importance of including WD in differential diagnosis of psychiatric disorders in young adults, as well as caution in initiating psychiatric treatment for patients with already established diagnosis of WD. Case report of a patient with primarily psychiatric manifestation of WD. The authors present the case of a 26-year-old patient treated for 3 years due to depressive syndrome who was diagnosed as WD in the differential diagnosis shortly after extrapyramidal symptoms developed. During the further WD treatment the manic episode occurred. The patient was treated with atypical neuroleptics and anxiolytics, with good psychiatric effect, but with severe neurological deterioration. However, long term use of valproic acid and olanzapine combined with continuation of anti-copper treatment and rehabilitation resulted in good psychiatric and neurological outcome. 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.