Psychiatric comorbidity in Wilson’s disease

Abstract

Wilson's disease (WD) is a relatively rare autosomal recessive inherited disorder causing copper accumulation in different organs, mainly the liver and brain. Psychiatric disturbances represent a diagnostic and therapeutic issue in WD. A search for relevant articles was carried out on PubMed/Medline, Scopus, and Google Scholar, for papers focused on psychiatric disorders in WD published between 1985-2016. Ninety-two articles were included in this review, showing the findings from 35 observational and case-control studies and 57 case reports. This study discussed the findings on the prevalence of psychiatric symptoms in WD, their impact on the life of those diagnosed, and the efficacy of available treatments on the psychiatric outcomes of WD. Psychiatric disorders are confirmed frequent in WD, with a high prevalence of mood disorders, and contribute to worse Quality-of-Life and psychosocial outcomes. Because specific therapies for WD lead to a good life expectancy, adherence to medicaments and clinical monitoring should be warranted by a multidisciplinary approach, including a hepathologic, neurologic, and psychiatric careful evaluation and education of those affected and their relatives.

Psychiatric manifestations in Wilson’s disease: possibilities and difficulties for treatment

“…All available antidepressant drugs, including tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), serotonin antagonist and reuptake inhibitors (SARIs), as well as electroconvulsive therapy (ECT) have been successfully used in the treatment of depressive syndromes in WD. 12 , 14 , 15 , 52 – 54 However, in some cases neurological deterioration occurred after TCA (imipramine) treatment. 55 …”

“… 1 , 11 However, some WD patients require treatment with additional drugs that target the problems that can arise over the course of WD, such as symptoms of liver failure (portal hypertension, coagulopathy, pancytopenia), skin changes, neurological symptoms including dysphagia, tremor, dystonia and sialorrhea, and psychiatric symptoms. 1 , 12 – 14 While treatment of the hepatic and neurological symptoms of WD has been established and there are published international recommendations for the general management of WD, liver failure, and transplantation, there are currently no recommendations for the management of psychiatric symptoms associated with WD. 14 , 15 …”

“… 1 , 12 – 14 While treatment of the hepatic and neurological symptoms of WD has been established and there are published international recommendations for the general management of WD, liver failure, and transplantation, there are currently no recommendations for the management of psychiatric symptoms associated with WD. 14 , 15 …”

Mental health and chronic diseases: a challenge to be faced from a new perspective

“…Wilson Disease is a rare inherited disorder causing copper accumulation in different organs, mainly the liver and brain. The systematic review by Mura, Zimbrean, Demelia, and Carta (2017) illustrates why psychiatric disturbances (especially depressive and bipolar disorders) represent a major diagnostic and therapeutic conundrum in Wilson Disease, which may contribute to lower Quality-of-Life and poorer therapeutic adherence. Therapies for this disease lead to a good life expectancy, provided therapeutic adherence is maintained with good clinical follow-up using a multidisciplinary approach, along with education about risks in those affected and their relatives.…”

Comparative effectiveness of common therapies for Wilson disease: A systematic review and meta‐analysis of controlled studies

“…24 For this purpose, we retrieved systematic reviews during title abstract screening that had a similar research question as we do, and that were described as 'systematic (literature) review' (semantic variations allowed) or that described a systematic literature search in their methods section. 22,23,[25][26][27][28][29][30][31]…”