Resolved Psychosis after Liver Transplantation in a Patient with Wilson’s Disease

Abstract

A psychiatric involvement is frequently present in Wilson’s disease. Psychiatric symptoms are sometimes the first and only manifestation of Wilson’s disease. More often a psychiatric involvement is present beside a neurologic or hepatic disease.We describe the case of a 18 years-old male patient who shows a clinic and laboratoristic pattern of cirrhosis and an history of subchronic hallucinatory psychosis, behavioral symptoms and mood disturbances with depressed mood. He hadn’t familiar history of liver or psychiatric disease. Laboratory and imaging tests confirmed the diagnosis of Wilson’s disease with psichiatric involvement. After liver transplantation copper metabolism and liver function normalised and we noticed no recurrency of the psichiatric illness. Very few cases of psychiatric improvement after orthotopic liver transplantation (OLT) has been described until now.

Encephalopathy in Wilson Disease: Copper Toxicity or Liver Failure?

“…34 Some WD patients suffering from only slight liver dysfunction remain normal in cognitive and psychic functioning, what was confirmed in detailed neuropsychological examinations. [35][36][37] The diagnosis of the overt HE is simpler because it relies on the basis of neurological and physical pathological signs. The situation in MHE is far more challenging as the condition in which patients reveal selective, subtle neuropsychological deficits while a neurological/physical examination does not disclose any disorders, and a patient often reports no complaints.…”

“…However, a few case reports confirmed that in this population (without evident brain involvement but presence of neurological symptoms) even severe psychiatric states may occur. Sorbello et al 37 described the case of a 18 years old WD patient with advanced cirrhosis and normal brain magnetic resonance imaging (MRI) scan developing a full clinical picture of psychosis (with hallucinations, delusions, insomnia and depression). He underwent immediately a liver transplantation.…”

<p>Graft Loss Following Onset of Schizophrenia Long After Liver Transplantation</p>

“…As for liver transplantation in particular, psychotic disorders have been reported in only a few cases. [10][11][12][13] In each of the four reported cases, the psychosis existed before transplantation. Long-term outcomes were good in three of the four cases.…”

Nosology and Phenomenology of Psychosis in Movement Disorders

“…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. 193 Psychotic symptoms may also be related to an ineffective zinc treatment. 194 Treatment of psychotic symptoms in WD includes penicillamine monotherapy, which resolves psychosis indirectly by improving copper metabolism.…”