Mania as a presenting symptom of Wilson's disease

Prabhat Kumar Chand, Pratima Murthy

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Wilson's disease commonly presents with neurological or hepatic manifestations. When it presents with only psychiatric symptoms, or with extrapyramidal symptoms secondary to neuroleptic exposure, the diagnosis of underlying Wilson's disease may be missed. Methods: An 18-year-old boy presented to the psychiatric clinic with a manic syndrome and high propensity for extrapyramidal symptoms to neuroleptic. Initial examination revealed splenomegaly and pancytopenia. Subsequent detection of Kayser-Fleischer ring and typical biochemical findings confirmed the diagnosis of Wilson's disease. Results: While the psychiatric symptoms came under control with lithium carbonate, extrapyramidal symptoms continue to persist even after neuroleptic withdrawal. Pancytopenia thought to be due to hypersplenism persists, and patient has developed features of liver cirrhosis. Treatment with zinc and folic acid has been started, and the patient is under evaluation for treatment with penicillamine. Conclusion: The psychiatrist needs to recognize that Wilson's disease can uncommonly present with isolated psychiatric symptoms, including mania. Early and severe extrapyramidal symptoms secondary to neuroleptic exposure in an adolescent age group warrants a detailed evaluation to rule out underlying neuropsychiatric conditions.

Original languageEnglish
Pages (from-to)47-49
Number of pages3
JournalActa Neuropsychiatrica
Volume18
Issue number1
DOIs
Publication statusPublished - 01-01-2006
Externally publishedYes

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Hepatolenticular Degeneration
Bipolar Disorder
Psychiatry
Antipsychotic Agents
Pancytopenia
Hypersplenism
Lithium Carbonate
Penicillamine
Splenomegaly
Folic Acid
Liver Cirrhosis
Zinc
Age Groups
Liver
Therapeutics

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Chand, Prabhat Kumar ; Murthy, Pratima. / Mania as a presenting symptom of Wilson's disease. In: Acta Neuropsychiatrica. 2006 ; Vol. 18, No. 1. pp. 47-49.
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Mania as a presenting symptom of Wilson's disease. / Chand, Prabhat Kumar; Murthy, Pratima.

In: Acta Neuropsychiatrica, Vol. 18, No. 1, 01.01.2006, p. 47-49.

Research output: Contribution to journalArticle

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AB - Objective: Wilson's disease commonly presents with neurological or hepatic manifestations. When it presents with only psychiatric symptoms, or with extrapyramidal symptoms secondary to neuroleptic exposure, the diagnosis of underlying Wilson's disease may be missed. Methods: An 18-year-old boy presented to the psychiatric clinic with a manic syndrome and high propensity for extrapyramidal symptoms to neuroleptic. Initial examination revealed splenomegaly and pancytopenia. Subsequent detection of Kayser-Fleischer ring and typical biochemical findings confirmed the diagnosis of Wilson's disease. Results: While the psychiatric symptoms came under control with lithium carbonate, extrapyramidal symptoms continue to persist even after neuroleptic withdrawal. Pancytopenia thought to be due to hypersplenism persists, and patient has developed features of liver cirrhosis. Treatment with zinc and folic acid has been started, and the patient is under evaluation for treatment with penicillamine. Conclusion: The psychiatrist needs to recognize that Wilson's disease can uncommonly present with isolated psychiatric symptoms, including mania. Early and severe extrapyramidal symptoms secondary to neuroleptic exposure in an adolescent age group warrants a detailed evaluation to rule out underlying neuropsychiatric conditions.

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