Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?

Introduction Wilson’s disease is a rare (1:30,000) autosomal recessive disorder of copper metabolism that is caused by mutations in the adenosine triphosphatase copper transporting beta (ATP7B) gene, located on chromosome 13. The reported percentage of patients with psychiatric symptoms as the pres...

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Main Authors: J. Marques, M. Bajouco
Format: Article
Language:English
Published: Cambridge University Press 2022-06-01
Series:European Psychiatry
Subjects:
Online Access:https://www.cambridge.org/core/product/identifier/S0924933822019824/type/journal_article
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author J. Marques
M. Bajouco
author_facet J. Marques
M. Bajouco
author_sort J. Marques
collection DOAJ
description Introduction Wilson’s disease is a rare (1:30,000) autosomal recessive disorder of copper metabolism that is caused by mutations in the adenosine triphosphatase copper transporting beta (ATP7B) gene, located on chromosome 13. The reported percentage of patients with psychiatric symptoms as the presenting clinical feature is 10%-20%. Objectives To present and discuss a rare case admitted in the First Psychotic Episode Inpatient Unit (UIPEP) with pleiomorphic psychotic symptoms and low serum copper and ceruloplasmin and high 24h urine copper. Methods The data was collected through patient and family interviews, as well as from his medical record. We searched Pubmed using MeSH terms: psychotic disorders AND Hepatolenticular Degeneration. Results A twenty-two years old male, without known psychiatric history presented in the Emergency Department with a myriad of psychotic symptoms: motor stereotypes/mannerisms, paranoid delusions and auditory hallucinations. He was admitted in UIPEP, started low-dose antipsychotic medication with good response. As part of the implemented protocol, he did a battery of exams, including Brain CT-scan, EEG, ECG and blood and urine analysis, in which low serum copper and ceruloplasmin stood out, leveraging the suspicion of Wilson´s disease. Therefore, 24h urine copper was done, with 140 mcg/d (reference range < 40 mcg/d). Brain MRI was normal and no Kayser–Fleisher rings were seen by a consulting ophthalmologist. Conclusions Without proper treatment, Wilson’s disease is a progressive and fatal disease. Therefore, it’s of upmost importance to recognize the clinical signs that raise suspicion of this disorder, especially recent onset in young adult of miscellaneous psychotic symptoms with movement disorders. Disclosure No significant relationships.
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spelling doaj.art-8c6333c49bc248ed9786bdf6cefb91e32023-11-17T05:06:21ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-06-0165S768S76810.1192/j.eurpsy.2022.1982Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?J. Marques0M. Bajouco1Centro Hospitalar Universitário do Algarve, Psychiatry, Portimão, PortugalCentro Hospitalar Universitário de Coimbra, Cri Psiquiatria, Coimbra, Portugal Introduction Wilson’s disease is a rare (1:30,000) autosomal recessive disorder of copper metabolism that is caused by mutations in the adenosine triphosphatase copper transporting beta (ATP7B) gene, located on chromosome 13. The reported percentage of patients with psychiatric symptoms as the presenting clinical feature is 10%-20%. Objectives To present and discuss a rare case admitted in the First Psychotic Episode Inpatient Unit (UIPEP) with pleiomorphic psychotic symptoms and low serum copper and ceruloplasmin and high 24h urine copper. Methods The data was collected through patient and family interviews, as well as from his medical record. We searched Pubmed using MeSH terms: psychotic disorders AND Hepatolenticular Degeneration. Results A twenty-two years old male, without known psychiatric history presented in the Emergency Department with a myriad of psychotic symptoms: motor stereotypes/mannerisms, paranoid delusions and auditory hallucinations. He was admitted in UIPEP, started low-dose antipsychotic medication with good response. As part of the implemented protocol, he did a battery of exams, including Brain CT-scan, EEG, ECG and blood and urine analysis, in which low serum copper and ceruloplasmin stood out, leveraging the suspicion of Wilson´s disease. Therefore, 24h urine copper was done, with 140 mcg/d (reference range < 40 mcg/d). Brain MRI was normal and no Kayser–Fleisher rings were seen by a consulting ophthalmologist. Conclusions Without proper treatment, Wilson’s disease is a progressive and fatal disease. Therefore, it’s of upmost importance to recognize the clinical signs that raise suspicion of this disorder, especially recent onset in young adult of miscellaneous psychotic symptoms with movement disorders. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933822019824/type/journal_articleWilson’s diseasePSYCHOTIC DISORDERSFirst Episode Psychosis
spellingShingle J. Marques
M. Bajouco
Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?
European Psychiatry
Wilson’s disease
PSYCHOTIC DISORDERS
First Episode Psychosis
title Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?
title_full Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?
title_fullStr Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?
title_full_unstemmed Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?
title_short Can pleiomorphic psychotic symptoms with movement disorders mask wilson’s disease?
title_sort can pleiomorphic psychotic symptoms with movement disorders mask wilson s disease
topic Wilson’s disease
PSYCHOTIC DISORDERS
First Episode Psychosis
url https://www.cambridge.org/core/product/identifier/S0924933822019824/type/journal_article
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