Alterações neuropsiquiátricas na doença de Wilson e uso da eletroconvulsoterapia: relato de caso

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

Wilson's disease (WD) is an inherited metabolic disorder related to disturbances of copper metabolism, and predominantly presents with liver and neuropsychiatric symptoms. In most cases it can be successfully treated with anti-copper agents, and both liver function and neuropsychiatric symptoms typically improve. Treatment guidelines for WD include recommendations for anti-copper treatment as well as for the treatment of liver failure symptoms. Recently, recommendations for treatment of the neurological symptoms of WD have also been proposed. Although most WD patients present with psychiatric symptoms at some stage of the disease, currently there are no guidelines for the treatment of the psychiatric manifestations. Treatment of the psychiatric symptoms of WD is often guided by general psychiatric experience, which typically glosses over the specificity of WD, and can result in severe neurological and/or hepatic complications. Here we review and discuss the possible treatments available for the mood disturbances, psychosis, behavioral and cognitive disorders that can occur in WD, as well as their efficacy.

Psychosis in an adolescent with Wilson's disease: A case report and review of the literature

Neuropsychiatric manifestations are common in Wilson's disease and mainly include extrapyramidal and cerebellar symptoms. Presentations with psychotic symptoms have been described less frequently. In this report we present the case of a young boy with Wilson's disease who developed psychotic symptoms. A 12-year-old boy was diagnosed with Wilson's disease on the basis of the physical examination findings and low ceruloplasmin levels (8.1 mg/dl). After 2 weeks of being diagnosed with Wilson's disease, he developed an acute onset illness, characterized by delusion of persecution, fearfulness, hypervigilence and decreased sleep. These symptoms were not associated with any confusion, clouding of consciousness, hallucinations and affective symptoms. There was no past or family history of psychosis. One week after the onset of the symptoms he was prescribed tab penicillamine, initially 250 mg/day, which was increased to 500 mg/day after 3 days. After increase in the dose of penicillamine, his psychiatric symptoms worsened and led to hospitalization. A diagnosis of organic delusional disorder (F06.2) due to Wilson's disease was considered. Tab risperidone 1 mg/day was started, and the dose of penicillamine was reduced with which symptoms resolved. Whenever a young adolescent develops psychosis, especially of delusional type, the possibility of Wilson's disease must be considered.

Psychiatric aspects of Wilson disease: a review

OBJECTIVE

To review the current evidence about psychiatric symptoms in Wilson's disease (WD).

METHOD

We searched Ovid, PsychInfo, CINHAL and PubMed databases from May 1946 to May 2012 using the key words Wilson('s) disease in combination with psychiatry, psychiatric, psychosis, schizophrenia, depression, mania, bipolar, mood, anxiety, personality and behavior.

RESULTS

Psychiatric symptoms occur before, concurrent with or after the diagnosis and treatment for WD. Thirty to forty percent of patients have psychiatric manifestations at the time of diagnosis, and 20% had seen a psychiatrist prior to their WD diagnosis. When psychiatric symptoms preceded neurological or hepatic involvement, the average time between the psychiatric symptoms and the diagnosis of WD was 864.3 days. The prevalence of psychiatric disorders in WD patients varies wildly (major depressive disorder, 4-47%; psychosis, 1.4-11.3%). Certain gene mutations of ATP7B may correlate with specific personality traits.

CONCLUSIONS

Psychiatric manifestations represent a significant part of the clinical presentation of WD and can present at any point in the course of the illness. Psychiatric manifestations occurring without overt hepatic or neurologic involvement may lead to misdiagnosis. A better understanding of the psychiatric presentations in WD may provide insights into the underlying mechanisms of psychiatric disorders.

Doença de Wilson: diagnóstico clínico e sinais das "faces do panda" à ressonância magnética. Relato de caso

Homem de 25 anos de idade foi internado com sintomatologia polimorfa típica das afecções dos gânglios da base, associada a manifestações psiquiátricas. Fez uso de periciazina; no entanto, a suspensão do medicamento não melhorou a sintomatologia. Foi estabelecido o diagnóstico de doença de Wilson pela visualização do anel de Kayser-Fleischer através de exame com lâmpada de fenda e pelos exames laboratoriais que mostraram diminuição da ceruloplasmina plasmática e aumento de excreção de cobre urinário. A ressonância magnética, ponderada em T2, em cortes axiais do mesencéfalo e ponte, evidenciou imagens das "faces do panda".