Wilson's Disease Psychosis in a Young Man With Autism Spectrum Disorder: A Case Report and Focus on Management

Wilson's disease is a rare autosomal recessive disorder, affecting approximately 1 in 30 000 individuals and is characterized by abnormal copper accumulation in the body, primarily affecting the liver and brain. Psychiatric manifestations as a first presentation, particularly psychosis, are less commonly recognized resulting in failure to begin treatment early in the course of the disease. This case report highlights a patient that presented to the hospital with psychosis, who was later diagnosed with Wilson's disease. This case underscores the importance of considering organic causes in first-episode psychosis.

An 18-year-old man with a history of autism spectrum disorder and epilepsy presented to the emergency room with symptoms of a panic attack. During his evaluation, he expressed suicidal ideation and was placed under a 72-hour involuntary hold, then transferred to an inpatient psychiatric unit. His symptoms had worsened during quarantine for military boot camp, and included auditory and visual hallucinations, severe panic attacks, and depression.The patient had a history of being bullied, a past suicide attempt, and significant psychosocial stressors, including a recent breakup. He also had a family history of schizophrenia. On admission, psychiatric rating scales revealed an overall illness score in the markedly ill range and a depression scale, which was scored as moderately severe. Initial laboratory tests for potential organic causes of first-episode psychosis showed abnormal copper and ceruloplasmin levels, prompting further investigation into Wilson's disease.During hospitalization, he was initially treated with aripiprazole, which was changed to quetiapine due to side effects. His hallucinations and suicidal ideations significantly improved with quetiapine. Outpatient evaluations, including a liver biopsy, confirmed the diagnosis of Wilson's disease. His symptoms were managed with chelation therapy, exercise, and dietary modifications, leading to improved psychiatric and physical health.

This case underscores the importance of considering organic etiologies in psychiatric presentations, particularly in young individuals. A multidisciplinary approach, involving thorough medical and psychiatric evaluations, was crucial in making the diagnosis of Wilson's disease and providing appropriate management. This case highlights the need for comprehensive diagnostic evaluations and integrated care to optimize outcomes for patients with complex psychiatric and medical conditions.