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

Characteristics of neurological Wilson's disease with corpus callosum abnormalities

BACKGROUND

Wilson's disease (WD) is an autosomal recessive disease of impaired copper metabolism. Previous study demonstrated that WD with corpus callosum abnormalities (WD-CCA) was limited to the posterior part (splenium). This study aimed to compare clinical features between WD-CCA and WD without corpus callosum abnormalities (WD-no-CCA).

METHODS

Forty-one WD patients who had markedly neurological dysfunctions were included in this study. We retrospectively reviewed clinical, biochemical characteristics and MRI findings in the 41 WD patients. All patients were assessed using the Unified Wilson's Disease Rating Scale.

RESULTS

Nine patients had corpus callosum abnormalities, 4 of 9 patients had abnormal signal in the genu and splenium, 5 of 9 patients had abnormal signal only in the splenium. WD-CCA had longer course (9.9 ± 4.0 years vs. 3.4 ± 3.6 years, p<0.01), more severe neurological dysfunctions (37.6 vs. 65.9, p<0.01) and higher psychiatric symptoms scores (11.2 vs. 22.5, p<0.01) than WD-no-CCA. The MRI findings indicated that WD-CCA had higher ratio than WD-no-CCA in globus pallidus (88.9% vs. 43.8%, p = 0.024) and thalamus (100% vs. 59.4%, p = 0.038). The index of liver function and copper metabolism had no significant in WD-CCA and WD-no-CCA patients.

CONCLUSION

Our findings indicate Wilson's disease can involve the posterior as well as the anterior part of CC and patients with CC involvement had more extensive brain lesions, more severe neurological dysfunctions and psychiatric symptoms.

Psychiatric comorbidity in Wilson's disease

Wilson's disease (WD) is a relatively rare autosomal recessive inherited disorder causing copper accumulation in different organs, mainly the liver and brain. Psychiatric disturbances represent a diagnostic and therapeutic issue in WD. A search for relevant articles was carried out on PubMed/Medline, Scopus, and Google Scholar, for papers focused on psychiatric disorders in WD published between 1985-2016. Ninety-two articles were included in this review, showing the findings from 35 observational and case-control studies and 57 case reports. This study discussed the findings on the prevalence of psychiatric symptoms in WD, their impact on the life of those diagnosed, and the efficacy of available treatments on the psychiatric outcomes of WD. Psychiatric disorders are confirmed frequent in WD, with a high prevalence of mood disorders, and contribute to worse Quality-of-Life and psychosocial outcomes. Because specific therapies for WD lead to a good life expectancy, adherence to medicaments and clinical monitoring should be warranted by a multidisciplinary approach, including a hepathologic, neurologic, and psychiatric careful evaluation and education of those affected and their relatives.

Screening for bipolar disorders: A public health issue

INTRODUCTION

Bipolar disorder (BD) is a public health issue; it is one of the leading causes of disability and its late diagnosis heightens the impact of the condition. Screening tools for early detection could be extremely useful.

METHODS

Narrative review on screening of BD.

RESULTS

Screening questionnaires have high sensitivity but relatively low specificity if DSM diagnoses are taken as the "gold standard". Critics maintain that an excess of false positives makes such tools unnecessary for identifying cases and of little use in screening studies consisting of two phases. However, "positive" screening was frequently homogeneous with BD in terms of gender, age, level of distress, low social functioning and employment rate, comorbidity with alcohol and substance abuse, heavy recourse to health care, use of mood stabilizers and antidepressants, risk of suicide attempts, and high recurrence of depressive episodes. While none of these components is pathognomonic of BD, their co-occurrence could identify subthreshold "cases". The studies reviewed found positivity at screening to be associated with impaired quality of life, even without BD and independently of comorbidity. Patients with a neurological disease and positive at screening show homogenous brain lesions, different from those of patients screening negative.

CONCLUSIONS

The results are coherent with the hypothesis that positivity identifies a bipolar spectrum of clinical and public health interest, including sub-threshold bipolar cases, which do not fulfil the diagnostic criteria for BD.

Dream Recall Frequencies and Dream Content in Wilson's Disease with and without REM Sleep Behaviour Disorder: A Neurooneirologic Study

Objective. Violent dream content and its acting out during rapid eye movement sleep are considered distinctive for rapid eye movement sleep behaviour disorder (RBD). This study reports first quantitative data on dreaming in a cohort of patients with treated Wilson's disease (WD) and in patients with WD with RBD. Methods. Retrospective questionnaires on different dimensions of dreaming and a prospective two-week home dream diary with self-rating of emotions and blinded, categorical rating of content by an external judge. Results. WD patients showed a significantly lower dream word count and very few other differences in dream characteristics compared to age- and sex-matched healthy controls. Compared to WD patients without RBD, patients with WD and RBD reported significantly higher nightmare frequencies and more dreams with violent or aggressive content retrospectively; their prospectively collected dream reports contained significantly more negative emotions and aggression. Conclusions. The reduction in dream length might reflect specific cognitive deficits in WD. The lack of differences regarding dream content might be explained by the established successful WD treatment. RBD in WD had a strong impact on dreaming. In accordance with the current definition of RBD, violent, aggressive dream content seems to be a characteristic of RBD also in WD.

Does Mood Disorder Questionnaire identify sub-threshold bipolarity? Evidence studying worsening of quality of life

OBJECTIVE

It is debated whether the Mood Disorder Questionnaire (MDQ) can generate false positives by screening other disorders as bipolar, or identify sub-threshold bipolarity. The aim is to verify if Quality of Life (QoL) impairment in MQD positives in the community is due to MDQ positivity itself, or to psychiatric diagnosis associated with MDQ positivity (supporting the former hypothesis).

METHOD

Community survey. Sample randomized after stratification of the adult population in the records of seven Italian regions.

TOOLS

MDQ; Short Form Health Survey (SF-12); semi-structured clinical interview carried out by clinicians.

RESULTS

Positives at MDQ show worsening QoL with an attributable burden of 2.8 ± 1.8 lower than in MDD (5.6 ± 3.6, p < 0.001) or Eating Disorders (4.4 ± 6.6, p < 0.03) and similar to Panic Disorder (2.9 ± 0.9, p = 0.44). The burden is lower in the middle-aged (25-59 years) than in the young (18-24) (4.65 ± 4.5 vs 2.58 ± 2.0, p=0.007) or in the elderly (≥60) (4.12 ± 3.2; p = 0.024). In the elderly the burden is independent from comorbid psychiatric disorders.

LIMITATIONS

This is a preliminary study based on one survey not designed to test this specific hypothesis, thus its results have a heuristic value only.

CONCLUSIONS

The worsening of QoL due to positivity at MDQ is largely independent from comorbid conditions, supporting the hypothesis that MDQ positivity identifies a specific area of suffering that is "subthreshold" to the psychiatric diagnosis, and relevant for public health.