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Abstract
Wilson disease is a rare copper metabolism disorder that generally occurs in individuals between 5 and 35 years of age. Common clinical manifestations are hepatic, neurological, and psychiatric symptoms. Roughly, 4% of all cases occur in patients over 40 years of age and, among these patients, the presenting symptoms are generally neuropsychiatric, which often leads to misdiagnosis as a primary psychiatric disorder and a delay in correct diagnosis. This report presents the case of a 49-year-old man with no formal psychiatric history who presented with a new onset of mania. We outline the distinctive characteristics that appeared inconsistent with a primary psychiatric disorder and pointed toward secondary mania. Despite low serum ceruloplasmin, the absence of brain abnormalities more typical of Wilson disease on magnetic resonance imaging led a neurology consultant to advise that the diagnosis was likely primarily psychiatric. Due to atypical components of the patient's presentation, such as his late age of onset for bipolar disorder and acute cognitive decline, the psychiatric team advocated for further diagnostic workup. The subsequent evaluation confirmed Wilson disease based on specific ophthalmological and hepatic abnormalities and further copper studies. In addition, once diagnosed, the management of Wilson disease involves distinct clinical considerations given patients' presumed vulnerability to neurological side effects. This case illustrates the role psychiatric providers play in advocating for diagnostic workup in patients with atypical presentations of primary psychiatric disorders and the distinct diagnostic and treatment considerations associated with Wilson disease.
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Commentary on "A New Onset of Mania in a 49-Year-Old Man: An Interesting Case of Wilson Disease". J Psychiatr Pract 2020; 26:510-517. [PMID: 33275389 DOI: 10.1097/pra.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Wilson disease is a rare copper metabolism disorder that generally occurs in individuals between 5 and 35 years of age. Common clinical manifestations are hepatic, neurological, and psychiatric symptoms. Roughly, 4% of all cases occur in patients over 40 years of age and, among these patients, the presenting symptoms are generally neuropsychiatric, which often leads to misdiagnosis as a primary psychiatric disorder and a delay in correct diagnosis. This report presents the case of a 49-year-old man with no formal psychiatric history who presented with a new onset of mania. We outline the distinctive characteristics that appeared inconsistent with a primary psychiatric disorder and pointed toward secondary mania. Despite low serum ceruloplasmin, the absence of brain abnormalities more typical of Wilson disease on magnetic resonance imaging led a neurology consultant to advise that the diagnosis was likely primarily psychiatric. Due to atypical components of the patient's presentation, such as his late age of onset for bipolar disorder and acute cognitive decline, the psychiatric team advocated for further diagnostic workup. The subsequent evaluation confirmed Wilson disease based on specific ophthalmological and hepatic abnormalities and further copper studies. In addition, once diagnosed, the management of Wilson disease involves distinct clinical considerations given patients' presumed vulnerability to neurological side effects. This case illustrates the role psychiatric providers play in advocating for diagnostic workup in patients with atypical presentations of primary psychiatric disorders and the distinct diagnostic and treatment considerations associated with Wilson disease.
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Walker G, Hussaini T, Stowe R, Cresswell S, Yoshida EM. Liver Transplant Can Resolve Severe Neuropsychiatric Manifestations of Wilson Disease: A Case Report. EXP CLIN TRANSPLANT 2016; 16:620-624. [PMID: 27915967 DOI: 10.6002/ect.2016.0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although liver transplant for decompensated cirrhosis secondary to Wilson disease is well accepted, the use of transplant for patients with severe neurologic manifestations of this condition remains controversial, and these can be perceived as a contraindication. Here, we describe a 45-year-old woman who presented with an incidental hepatocellular carcinoma at the time of transplant. The patient had severe neurologic manifestations of Wilson disease pretransplant, including dysarthria, hyperreflexia, asymmetrical ataxia, tremor, bradyphrenia, and shuffling gait. She underwent successful transplant from a hepatic and surgical standpoint, but her postoperative course was marked by protracted mutism, hypophonia, and fluctuating akinesia and immobility that did not respond promptly to withdrawal of calcineurin inhibitors or pramipexole but did respond robustly to amantadine. At 9 months posttransplant, there was marked neurologic improvement, and, at 18 months, she exhibited subtle memory and organizational difficulties but was fully ambulatory and otherwise completely functional. Our experience suggests that even patients with severe neurologic Wilson disease may recover after transplant, albeit slowly, demonstrating the need for a multidisciplinary approach, including pre- and posttransplant neurologic and neuropsychiatric consultations.
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Affiliation(s)
- Gregory Walker
- From the Division of Neurology, University of British Columbia, Canada
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Leggio L, Addolorato G, Abenavoli L, Gasbarrini G. Wilson's Disease: Clinical, Genetic and Pharmacological Findings. Int J Immunopathol Pharmacol 2016; 18:7-14. [PMID: 15698506 DOI: 10.1177/039463200501800102] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Wilson's disease (WD) is an autosomal recessive disorder characterized by copper accumulation and toxicity in the liver and in other tissues. WD presents with liver disease, neurological or psychiatric disturbances or other less common clinical features. Diagnosis of WD is often difficult and may be formulated through clinical, biochemical, imaging, histochemical and genetic evaluations. Pharmacological approach in WD consists in copper chelating agents such as D-penicillamine, trientine, dimercaprol and tetrathiomolybdate. In 1997 zinc was approved for maintenance therapy of WD by the U.S. FDA. Orthotopic Liver Transplantation is indicated in fulminant hepatic failure, progressive hepatic insufficiency despite therapy, cirrhosis with complications of portal hypertension. However the most appropriate therapy, including OLT, remains controversial in WD and further studies are needed especially in order to differentiate the possibility of specific therapies for different WD phenotypes.
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Affiliation(s)
- L Leggio
- Institute of Internal Medicine, Catholic University of Rome, Italy
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Maurya PK, Kulshreshtha D, Singh AK, Thakkar MD, Thacker AK. Chronic psychosis, delayed diagnosis and Wilson's disease. QJM 2016; 109:339-40. [PMID: 26559080 PMCID: PMC4888330 DOI: 10.1093/qjmed/hcv214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- P K Maurya
- From the Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomati Nagar, Lucknow 206010, India
| | - D Kulshreshtha
- From the Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomati Nagar, Lucknow 206010, India
| | - A K Singh
- From the Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomati Nagar, Lucknow 206010, India
| | - M D Thakkar
- From the Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomati Nagar, Lucknow 206010, India
| | - A K Thacker
- From the Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomati Nagar, Lucknow 206010, India
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Bonnot O, Herrera P, Kuster A. [Treatable neurometabolic diseases. Association with schizophrenia spectrum disorders]. Presse Med 2015; 44:889-97. [PMID: 26248708 DOI: 10.1016/j.lpm.2015.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/10/2015] [Accepted: 02/17/2015] [Indexed: 11/18/2022] Open
Abstract
Schizophrenia spectrum disorders are presented on 1% of subjects over general population. Organic pathologies prevalence in schizophrenia spectrum patients is not well determined, and it is probably underestimated. In the present update review, we are going to highlight seven treatable neurometabolic diseases (NMD) associated to sub-clinic neurological symptoms. It is not infrequent to witness the absence of any clinical neurological signs going along with the NMD. Psychiatric symptoms may be the only clinical alarm that can guide physicians to an acute diagnosis. This is why it is a challenging pathology, defying our clinical accuracy as psychiatrist or any other practitioners confronted to this population. Hereby we are going to expose a literature review and comprehensive tables in order to present in a glance the essential clinical features of disorders of homocysteine metabolism, urea cycle disorders, Niemann-Pick disease type C, acute porphyria, cerebrotendinous-xanthomatosis. These conditions are sensible to major improvement strongly correlated to the accuracy of diagnosis. Literature analysis led us to propose a comprehensive list of atypical psychiatric symptoms including highly predominant visual hallucinations, compared to auditory ones, as well as confusion, catatonia or progressive cognitive decline. We highlight the importance of considering antipsychotic treatment resistance as a crucial sign leading to suspect an organic factor beneath the psychiatric features.
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Affiliation(s)
- Olivier Bonnot
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, CHU de Nantes, université de Nantes, 44093 Nantes, France.
| | - Paula Herrera
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, CHU de Nantes, université de Nantes, 44093 Nantes, France; Service de pédiatrie, centre hospitalier universitaire de Nantes, Nantes, France
| | - Alice Kuster
- Service de pédiatrie, centre hospitalier universitaire de Nantes, Nantes, France
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Bonnot O, Herrera PM, Tordjman S, Walterfang M. Secondary psychosis induced by metabolic disorders. Front Neurosci 2015; 9:177. [PMID: 26074754 PMCID: PMC4436816 DOI: 10.3389/fnins.2015.00177] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 04/30/2015] [Indexed: 11/13/2022] Open
Abstract
Metabolic disorders are not well-recognized by psychiatrists as a possible source of secondary psychoses. Inborn errors of metabolism (IEMs) are not frequent. Although their prompt diagnosis may lead to suitable treatments. IEMs are well-known to pediatricians, in particular for their most serious forms, having an early expression most of the time. Recent years discoveries have unveiled later expression forms, and sometimes very discreet first physical signs. There is a growing body of evidence that supports the hypothesis that IEMs can manifest as atypical psychiatric symptoms, even in the absence of clear neurological symptoms. In the present review, we propose a detailed overview at schizophrenia-like and autism-like symptoms that can lead practitioners to bear in mind an IEM. Other psychiatric manifestations are also found, as behavioral, cognitive, learning, and mood disorders. However, they are less frequent. Ensuring an accurate IEM diagnosis, in front of these psychiatric symptoms should be a priority, in order to grant suitable and valuable treatment for these pathologies.
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Affiliation(s)
- Olivier Bonnot
- Psychology Laboratory of Pays de la Loire (LPPL), U2PEA Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire de Nantes, University of Angers Nantes, France
| | - Paula M Herrera
- Psychology Laboratory of Pays de la Loire (LPPL), U2PEA Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire de Nantes, University of Angers Nantes, France ; Grupo de Investigación en Neurociencias NeURos, Universidad del Rosario Bogota, Colombia
| | - Sylvie Tordjman
- Department of Child an Adolescent Psychiatry, Centre Hospitalier Guillaume Regnier, University of Rennes Rennes, France
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital Melbourne, VIC, Australia ; Melbourne Neuropsychiatry Centre, University of Melbourne Melbourne, VIC, Australia
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Grover S, Sarkar S, Jhanda S, Chawla Y. Psychosis in an adolescent with Wilson's disease: A case report and review of the literature. Indian J Psychiatry 2014; 56:395-8. [PMID: 25568485 PMCID: PMC4279302 DOI: 10.4103/0019-5545.146530] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddharth Sarkar
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Soumya Jhanda
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yogesh Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bonnot O, Klünemann HH, Sedel F, Tordjman S, Cohen D, Walterfang M. Diagnostic and treatment implications of psychosis secondary to treatable metabolic disorders in adults: a systematic review. Orphanet J Rare Dis 2014; 9:65. [PMID: 24775716 PMCID: PMC4043981 DOI: 10.1186/1750-1172-9-65] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/24/2014] [Indexed: 12/18/2022] Open
Abstract
Objective It is important for psychiatrists to be aware of certain inborn errors of metabolism (IEMs) as these rare disorders can present as psychosis, and because definitive treatments may be available for treating the underlying metabolic cause. A systematic review was conducted to examine IEMs that often present with schizophrenia-like symptoms. Data sources Published literature on MEDLINE was assessed regarding diseases of homocysteine metabolism (DHM; cystathionine beta-synthase deficiency [CbS-D] and homocysteinemia due to methyltetrahydrofolate reductase deficiency [MTHFR-D]), urea cycle disorders (UCD), acute porphyria (POR), Wilson disease (WD), cerebrotendinous-xanthomatosis (CTX) and Niemann-Pick disease type C (NP-C). Study selection Case reports, case series or reviews with original data regarding psychiatric manifestations and cognitive impairment published between January 1967 and June 2012 were included based on a standardized four-step selection process. Data extraction All selected articles were evaluated for descriptions of psychiatric signs (type, severity, natural history and treatment) in addition to key disease features. Results A total of 611 records were identified. Information from CbS-D (n = 2), MTHFR-D (n = 3), UCD (n = 8), POR (n = 12), WD (n = 11), CTX (n = 14) and NP-C publications (n = 9) were evaluated. Six non-systematic literature review publications were also included. In general, published reports did not provide explicit descriptions of psychiatric symptoms. The literature search findings are presented with a didactic perspective, showing key features for each disease and psychiatric signs that should trigger psychiatrists to suspect that psychotic symptoms may be secondary to an IEM. Conclusion IEMs with a psychiatric presentation and a lack of, or sub-clinical, neurological signs are rare, but should be considered in patients with atypical psychiatric symptoms.
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Affiliation(s)
- Olivier Bonnot
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire de Nantes, Hôpital Mère-Enfant, 7 quai Moncousu, 44 000 Nantes, France.
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Hayhow BD, Hassan I, Looi JCL, Gaillard F, Velakoulis D, Walterfang M. The neuropsychiatry of hyperkinetic movement disorders: insights from neuroimaging into the neural circuit bases of dysfunction. Tremor Other Hyperkinet Mov (N Y) 2013; 3:tre-03-175-4242-1. [PMID: 24032090 PMCID: PMC3760049 DOI: 10.7916/d8sn07pk] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/08/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Movement disorders, particularly those associated with basal ganglia disease, have a high rate of comorbid neuropsychiatric illness. METHODS We consider the pathophysiological basis of the comorbidity between movement disorders and neuropsychiatric illness by 1) reviewing the epidemiology of neuropsychiatric illness in a range of hyperkinetic movement disorders, and 2) correlating findings to evidence from studies that have utilized modern neuroimaging techniques to investigate these disorders. In addition to diseases classically associated with basal ganglia pathology, such as Huntington disease, Wilson disease, the neuroacanthocytoses, and diseases of brain iron accumulation, we include diseases associated with pathology of subcortical white matter tracts, brain stem nuclei, and the cerebellum, such as metachromatic leukodystrophy, dentatorubropallidoluysian atrophy, and the spinocerebellar ataxias. CONCLUSIONS Neuropsychiatric symptoms are integral to a thorough phenomenological account of hyperkinetic movement disorders. Drawing on modern theories of cortico-subcortical circuits, we argue that these disorders can be conceptualized as disorders of complex subcortical networks with distinct functional architectures. Damage to any component of these complex information-processing networks can have variable and often profound consequences for the function of more remote neural structures, creating a diverse but nonetheless rational pattern of clinical symptomatology.
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Affiliation(s)
- Bradleigh D. Hayhow
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Islam Hassan
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
| | - Jeffrey C. L. Looi
- Academic Unit of Psychiatry & Addiction Medicine, Australian National University Medical School, Canberra Hospital, Canberra, Australia
| | | | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
| | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Parkville, Australia
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Weber SL, Segal S, Packman W. Inborn errors of metabolism: psychosocial challenges and proposed family systems model of intervention. Mol Genet Metab 2012; 105:537-41. [PMID: 22532988 DOI: 10.1016/j.ymgme.2012.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Inborn errors of metabolism result in psychosocial crises that challenge individual and familial modes of functioning across the life cycle. Increased stress, mood disorders, interpersonal challenges, decreased quality of life, and grief reactions are all common for patients and their families. To effectively care for these patients, a holistic approach to their care, which incorporates their social context, is essential. Patients and their families need support as they focus on immediate practical demands, grieve over illness-related losses, and reorient future expectations. A family systems based model provides a flexible and individualized approach to care that allows for optimal psychosocial adjustment throughout the disease process.
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Affiliation(s)
- Stacy L Weber
- Palo Alto University, Department of Psychology, Palo Alto, CA 94304, USA.
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Abstract
Wilson's disease (WD) is a relatively rare disease of copper metabolism. The diagnosis is often missed initially. The presentation is usually neurologic or hepatic, seen in 40% of patients. Psychiatric presentation of WD is reported in only 15% of patients. We present a 32-year-old patient with severe psychiatric manifestations. On examination, he had mild rest and postural tremors and a KF ring was seen. Serum ceruloplasmin was low and 24-hour urinary copper was elevated. The patient responded to penicillamine, lorazepam and quetiapine, and is being followed up.
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Affiliation(s)
- Rahul T Chakor
- Department of Neurology, T. N. M. C. and B. Y. L. Nair Charitable Hospital, Mumbai Central, Mumbai, Maharashtra, India
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Abstract
Copper and iron are transition elements essential for life. These metals are required to maintain the brain's biochemistry such that deficiency or excess of either copper or iron results in central nervous system disease. This review focuses on the inherited disorders in humans that directly affect copper or iron homeostasis in the brain. Elucidation of the molecular genetic basis of these rare disorders has provided insight into the mechanisms of copper and iron acquisition, trafficking, storage, and excretion in the brain. This knowledge permits a greater understanding of copper and iron roles in neurobiology and neurologic disease and may allow for the development of therapeutic approaches where aberrant metal homeostasis is implicated in disease pathogenesis.
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Affiliation(s)
- Erik Madsen
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63130, USA.
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Abstract
We present the case of a 21-year-old young lady with Wilson's disease, asymptomatic at first and consequently declining prophylaxis with chelating agents, who presented years after her diagnosis was made with multiple motor and neuropsychiatric manifestations of the disease, causing extensive morbidity and a major decrease in her quality of life. Following extensive education and supportive therapy, she showed conviction in the need for therapy. On close follow-up she continues to show compliance with appointments, the prescribed chelating agents, and psychotropic medication.
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Rodríguez Nieva N, Febrer Rotger A, Meléndez Plumed M, Vernet Bori A. [Osteoarthropathy in three siblings with Wilson's disease]. An Pediatr (Barc) 2004; 61:181-4. [PMID: 15274886 DOI: 10.1016/s1695-4033(04)78379-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Osteoarthropathies are one of the less usual manifestations of Wilson's disease. They appear in different forms such as osteoporosis (the most frequent), inflammatory changes in small joints, osteomalacia, osteoarthritis in younger ages, spine osteochondritis, fractures and heterotopic ossification. This article describes the different osteoarthropathies in three children: two brothers and one sister with Wilson's disease that first manifested in early childhood with severe neurological signs. After drug treatment and an intense rehabilitation program, the clinical signs stabilized. During the course of the disease, all three children presented fractures of the ulna and radius after low energy trauma, several heterotopic ossifications, some of which were asymptomatic, and inflammatory processes such as hip synovitis and reduction in mineral bone density. The etiology of this kind of manifestation is not yet clear, although the most widely accepted explanation is alteration in calcium and phosphate metabolism.
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Affiliation(s)
- N Rodríguez Nieva
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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Affiliation(s)
- Jonathan D Gitlin
- Edward Mallincroft Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Rodrigues ACT, Dalgalarrondo P. Alterações neuropsiquiátricas na doença de Wilson e uso da eletroconvulsoterapia: relato de caso. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:876-80. [PMID: 14595502 DOI: 10.1590/s0004-282x2003000500034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A doença de Wilson (DW) é condição sistêmica decorrente de erro inato do metabolismo, com importantes manifestações neuropsiquiátricas. Estas requerem identificação diagnóstica adequada e intervenções terapêuticas eficazes. Existem, estabelecidos, quatro clusters de sintomas neuropsiquiátricos na DW: distúrbios de comportamento e/ou personalidade, distúrbios do humor, déficit cognitivo e quadros psicóticos. Embora tais pacientes sejam vistos, mais comumente, em clínicas neurológicas e de hepatologia, os profissionais de saúde mental devem manter alto nível de suspeição para DW, já que os quadros iniciais podem se manifestar como síndromes psiquiátricas. Neste artigo é apresentada uma revisão da literatura sobre os aspectos neuropsiquiátricos da doença de Wilson, enfatizando-se as dificuldades diagnósticas. Um homem de 26 de idade DW com apresentação psiquiátrica inicial polimórfica é apresentado. O tratamento deste paciente com a eletroconvulsoterapia é relatado, somando-se esta forma de intervenção terapêutica, neste caso, aos dois únicos existentes na literatura
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Affiliation(s)
- Adriano C T Rodrigues
- Departamento de Psicologia Médica e Psiquiatria, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Abstract
Inborn errors of metabolism often present with a variety of psychiatric symptoms. With improved diagnosis and treatment options, many patients have increased lifespans; consequently, issues of long-term quality of life are coming to the forefront. Mental health concerns are among these issues. To demonstrate the connection between the course of metabolic disease and its psychiatric manifestations, four different inborn errors of metabolism are reviewed: phenylketonuria, Wilson disease, acute intermittent porphyria, and metachromatic leukodystrophy.
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Affiliation(s)
- Y Estrov
- Department of Psychiatry, University of California, San Diego, USA
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Abstract
OBJECTIVE To describe the course of depression in a patient with hepatolenticular degeneration (Wilson's disease). CLINICAL PICTURE A 21-year-old male with hepatolenticular degeneration is described in whom depression was the earliest manifestation. Insomnia and psychomotor slowing were prominent. TREATMENT The mood disturbance showed limited response to tricyclic antidepressants, mianserin, lithium augmentation and initial decoppering therapy. Introduction of the chelating agent tetrathiomolybdate was followed by normalisation of mood and improvement in non-psychiatric symptoms. OUTCOME Three years after the disorder was first diagnosed the patient was euthymic and fully functional. CONCLUSIONS Although hepatolenticular degeneration is rare, it commonly presents with psychiatric symptoms. It is important for psychiatrists to be aware of the condition and its psychiatric manifestations.
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Affiliation(s)
- G Walter
- Rivendell Unit, Central Sydney Area Health Service, Hospital Road, Concord West, New South Wales, Australia
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Adams M, Kutcher S, Antoniw E, Bird D. Diagnostic utility of endocrine and neuroimaging screening tests in first-onset adolescent psychosis. J Am Acad Child Adolesc Psychiatry 1996; 35:67-73; discussion 73. [PMID: 8567615 DOI: 10.1097/00004583-199601000-00014] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the diagnostic utility of endocrine and neuroimaging screening tests in first-onset adolescent psychosis. METHOD 111 consecutively admitted adolescents (aged 13 through 19 years) who presented with a first-onset psychosis and who had an unremarkable medical history and normal physical examination were given a battery of endocrine and neuroimaging screening tests. Diagnostic utility of a screening test was defined as an abnormal result (a positive test) that either led to a previously unknown or unsuspected medical diagnosis or played an important role in the clinical care of the patient. RESULTS 15.4% of the endocrine screening tests and 11.0% of the neuroimaging screening tests were identified as positive. However, no endocrine and no neuroimaging tests met criteria for diagnostic utility. The direct cost of this screening battery was $636.95 per patient. CONCLUSION Routine endocrine and neuroimaging screening tests in first-onset adolescent psychosis provide no diagnostic utility and are not cost-effective. Selective use of appropriate endocrine and neuroimaging diagnostic tests in populations with symptoms suggestive of organic disorders should replace routine screening procedures.
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Affiliation(s)
- M Adams
- Department of Psychiatry, University of Toronto, Canada
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Abstract
Wilson's disease is a rare genetic disorder involving the liver and brain, with onset frequently in adolescence. Psychiatric symptoms are often the first manifestation of the disease and can obscure the diagnosis. Chelation therapy can reverse the fatal outcome of untreated patients, so early detection is critically important. This paper describes an adolescent with Wilson's disease who, after initiation of penicillamine therapy, developed florid psychosis that improved as copper levels were decreased and that did not require use of neuroleptic medication.
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Affiliation(s)
- L V McDonald
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City 66160-7341, USA
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