Amantadine-induced psychosis in Wilson disease

Wilson disease is a rare genetic disorder of copper metabolism causing hepatic dysfunction and neuro-psychiatric manifestations. While psychosis in Wilson disease is uncommon, it can occur, especially with certain medications. We describe a 40-year-old woman diagnosed with Wilson disease who developed psychotic symptoms following the initiation and dose escalation of amantadine, a drug commonly used to treat parkinsonism associated with the disorder. Her symptoms included delusions of persecution, irritability and anomalous self-experiences such as 'made' phenomena, which are typically seen in schizophrenia. The psychosis resolved after discontinuing amantadine, without worsening her neurological symptoms. This underscores the importance of monitoring for psychiatric side-effects, particularly Schneiderian first-rank symptoms, in patients with Wilson disease being treated with amantadine. The findings suggest a probable adverse drug reaction, highlighting the need for careful evaluation and dose adjustments in such complex clinical cases.