Long-term mood disorder antedating the diagnosis of Wilson's disease

Abstract

Presents a case report of a 17-year-old woman, the daughter of consanguineous parents, was admitted to a university hospital with the diagnosis of cryptogenic cirrhosis. Her clinical history revealed that, since the age of nine, she had been experiencing a series of episodes of excessive fear, anxiety and depression. As her depressive symptoms grew steadily worse, she was put on antidepressants, including amytriptiline and fluoxetine. At the age of 12, she committed two suicide attempts, which were followed by an episode of frank mania with psychotic symptoms, evidenced by her attempt to bury herself up. Between the ages of 12 and 17, she remained on mood stabilizing agents, including carbamazepine and valproic acid. This course of treatment was, however, unsuccessful. Six months before hospitalization, she experienced weight gain and diffuse abdominal pain, followed by nausea and hyporexia. Ultrasonography and computed tomography (CT) of the abdomen revealed cirrhosis and ascites. When admitted to the hospital, her abdominal pain had worsened and she presented with severe ascites and delirium. Neurological examination showed diffuse hyperreflexia and ankle clonus. Kayser-Fleischer rings were present bilaterally. Further investigation yielded 13 points on the Child-Pugh's classification. Wilson's disease (WD) is an autosomal recessive genetic disorder related to the metabolism of copper, which accumulates in several tissues such the brain, liver and cornea. Neurological and psychiatric symptoms may occur due to the presence of such copper deposits in the brain. This case report aims at emphasizing the relevance of considering WD as a possible diagnosis in young patients with psychiatric symptoms, especially in those with a family and past history of jaundice, extrapyramidal features, neuropsychiatric disorder and premature deaths of other siblings. Awareness about the heterogeneity of WD and a high rate of suspicion may have a prognostic implication. (PsycINFO Database Record (c) 2012 APA, all rights reserved).