Gen Hosp Psychiatry. 2014 Jan-Feb;36(1):53-62. doi: 10.1016/j.genhosppsych.2013.08.007. Epub 2013 Oct 9.

Psychiatric aspects of Wilson disease: a review.

Zimbrean PC1, Schilsky ML2.

• 1Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Wilson Disease Centers of Excellence at Yale University, New Haven, CT. Electronic address: paula.zimbrean@yale.edu.
• 2Wilson Disease Centers of Excellence at Yale University, New Haven, CT; Section of Digestive Disease and Transplant and Immunology, Yale University School of Medicine; Yale Transplantation Center, Yale New Haven Hospital, New Haven, CT.

Abstract

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.

© 2014.

KEYWORDS:

Ceruloplasmin; Copper; Psychiatry; Schizophrenia; Wilson's disease

PMID:

24120023