Abstract
Various psychiatric symptoms, including depressive mood, cognitive dysfunction, and psychosis, have been observed in the course of Wilson disease, however both domestic and international case reports on Wilson disease presenting with typical mania before the onset of neurological or hepatic symptoms are rare. Even though the delayed diagnosis of Wilson disease can lead to irreversible impairment, including liver cirrhosis, diagnosis of Wilson disease usually takes more than two years for patients showing psychiatric symptoms as their first manifestation. Without careful observation and adequate understanding of the disease, clinicians may overlook signs and symptoms suggesting Wilson disease in patients showing typical psychiatric symptoms such as mania. In order to promote clinician's vigilance in detecting symptoms and signs of Wilson disease in patients showing symptoms of bipolar disorder, we report on a rare case of a 31-year-old male Wilson disease patient who developed symptoms of typical bipolar disorder before the onset of neurological or hepatic symptoms.
References
2. Taly AB, Meenakshi-Sundaram S, Sinha S, Swamy HS, Arunodaya GR. Wilson disease: description of 282 patients evaluated over 3 decades. Medicine (Baltimore). 2007; 86:112–121.
3. Dening TR, Berrios GE. Wilson's disease. Psychiatric symptoms in 195 cases. Arch Gen Psychiatry. 1989; 46:1126–1134.
4. Zimbrean PC, Schilsky ML. Psychiatric aspects of Wilson disease: a review. Gen Hosp Psychiatry. 2014; 36:53–62.
5. Carta MG, Sorbello O, Moro MF, Bhat KM, Demelia E, Serra A, et al. Bipolar disorders and Wilson's disease. BMC Psychiatry. 2012; 12:52.
6. Carta M, Mura G, Sorbello O, Farina G, Demelia L. Quality of life and psychiatric symptoms in Wilson's disease: the relevance of bipolar disorders. Clin Pract Epidemiol Ment Health. 2012; 8:102–109.
7. Chand PK, Murthy P. Mania as a presenting symptom of Wilson's disease. Acta Neuropsychiatr. 2006; 18:47–49.
8. Machado AC, Deguti MM, Caixeta L, Spitz M, Lucato LT, Barbosa ER. Mania as the first manifestation of Wilson's disease. Bipolar Disord. 2008; 10:447–450.
9. Varghese ST, Narayanan D, Dinesh D. Mania in a patient with Wilson's disease awaiting liver transplant. J Neuropsychiatry Clin Neurosci. 2008; 20:501–502.
10. Rybakowski JK, Litwin T, Chlopocka-Wozniak M, Czlonkowska A. Lithium treatment of a bipolar patient with Wilson' disease: a case report. Pharmacopsychiatry. 2013; 46:120–121.
11. Mitra S, Ray AK, Roy S. Control of mania with chelation-only in a case of Wilson's disease. J Neuropsychiatry Clin Neurosci. 2014; 26:E6.
12. Oder W, Grimm G, Kollegger H, Ferenci P, Schneider B, Deecke L. Neurological and neuropsychiatric spectrum of Wilson's disease: a prospective study of 45 cases. J Neurol. 1991; 238:281–287.
13. Brewer GJ. Recognition, diagnosis, and management of Wilson's disease. Proc Soc Exp Biol Med. 2000; 223:39–46.