Wilson Disease Patients with Atypical Psychiatric Symptoms

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Wilson disease is an autosomal recessive disorder of copper metabolism. The disease phenotype includes chronic liver disease (cirrhosis), neurological impairment (extra pyramidal signs), Kayser-Fleischer ring and others. Some patients show psychiatric symptoms. In this paper, we report two patients with Wilson disease who presented with atypical psychiatric symptoms as first symptoms. They presented with hallucination as the initial symptom and were diagnosed with schizophrenia. Several years later, typical neurological symptoms of Wilson disease appeared. The most common psychiatric symptoms are mental retardation and depression in Wilson disease; hallucination is a rare symptom. The clinical courses of these patients were atypical of this disease. Thus, the diagnosis of Wilson disease was unsuspected until they developed obvious symptoms, and a long time was needed to reach the final diagnosis. We should suspect Wilson disease and screen for it in patients with psychiatric symptoms.

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