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Depression in hepatolenticular degeneration (Wilson's disease)
1Rivendell Unit, Central Sydney Area Health Service, Hospital Road, Concord West, New South Wales, Australia.
Objective:
To describe the course of depression in a patient with hepatolenticular degeneration (Wilson's disease).
Clinical Picture:
A 21-year-old male with hepatolenticular degeneration is described in whom depression was the earliest manifestation. Insomnia and psychomotor slowing were prominent.
Treatment:
The mood disturbance showed limited response to tricyclic antidepressants, mianserin, lithium augmentation and initial decoppering therapy. Introduction of the chelating agent tetrathiomolybdate was followed by normalisation of mood and improvement in non-psychiatric symptoms.
Outcome:
Three years after the disorder was first diagnosed the patient was euthymic and fully functional.
Conclusions:
Although hepatolenticular degeneration is rare, it commonly presents with psychiatric symptoms. It is important for psychiatrists to be aware of the condition and its psychiatric manifestations.