Misidentification of Wilson Disease as Schizophrenia (1998-2013): Case Report and Review

Abstract

Wilson's disease (WD) is a neurodegenerative disorder due to copper metabolism. Schizophrenia-like psychosis and delusional disorder are rare forms of psychiatric manifestations of WD. The lack of recognition of these signs and symptoms as being attributable to WD often leads to delays in diagnosis and management. Knowledge about relationship of the psychiatric manifestations to WD can help with the administration of adequate management aimed at both the psychiatric issues and underlying WD. The objectives of this article are to review case reports whose subject is the incorrect diagnosis of schizophrenia or schizophrenia-like syndrome in patients with WD and to detail one case of this mismanagement of the disease. A 35-year-old unmarried Iranian woman presented to the consulting psychiatrist in the emergency room after a suicide attempt due to commanding auditory hallucination. She had previous eleven admissions in psychiatric hospital with major depressive episode with psychotic features, schizoaffective disorders, and then schizophrenia diagnosis. Nineteen years after her first symptoms, it was discovered that the patient was suffering from WD. We searched Google Scholar, Ovid, PsycINFO, CINHAL, and PubMed databases from 1985 to 2015. Finally, 14 researches were entered into the study. Psychiatric manifestations may precede the diagnosis of WD and other symptoms related to neurological or hepatic impairment. Early detection of WD is important to prevent catastrophic outcome. Young patients presenting with psychiatric presentations along with abnormal movement disorder, seizure, or conversion-like symptoms should be evaluate for WD even if signs and symptoms are typically suggestive of schizophrenia or manic episode. An interdisciplinary approach with good collaboration of psychiatrists and neurologists is crucial for WD because early diagnosis and management without delay is an important for good prognosis.

Nosology and Phenomenology of Psychosis in Movement Disorders

“…This poses an important differential diagnosis with schizophrenia. In most cases in which psychotic symptoms were the first manifestation of WD, these were paranoid delusions and hallucinations . Psychotic symptoms during the course of WD are similar to those appearing at disease onset .…”

“…In most cases in which psychotic symptoms were the first manifestation of WD, these were paranoid delusions and hallucinations. 180,186,187 Psychotic symptoms during the course of WD are similar to those appearing at disease onset. 188,189 Psychosis may be related to discontinuation of penicillamine treatment, 190,191 which usually reverts after treatment is restored or antipsychotics prescribed 192 or after liver transplantation.…”

Coexistence of seizure with Wilson's disease: a systematic review

“…Firstly, multiple seizure types were noted in some patients, for example in the Berger et al case report the patient developed recurrent generalised tonic‐clonic seizures followed by complete partial SE. Secondly, six studies did not report the seizure type while eight studies did not report EEG findings. Lastly, available data are mostly of case reports, case series and low sample size studies with consequent selection bias.…”

Schizophrenia-like disorder in Wilson's disease

“…Запаздывание диагностики БВ с психотическими симптомами составляет от нескольких месяцев до десятков лет [19,[22][23][24]. Следовательно, БВ необходимо включать в дифференциальную диагностику психотических состояний, особенно у молодых людей с первичным психотическим эпизодом [3,16,17,19,[25][26][27][28][29].…”

“…Раннее выявление БВ и вовремя назначенная специфическая терапия улучшают качество жизни больных и спо-собствует их реабилитации [26,29,30]. Однако в дальнейшем, несмотря на успешное лечение БВ, возможно ухудшение психического здоровья как вследствие явлений печеночной энцефалопатии, так и независимо от нее [31].…”