Objective: Wilson’s disease (WD) is a rare disorder of copper metabolism
with hepatic, neurological and psychiatric manifestations. This case describes
insomnia as a rare primary psychiatric presentation of WD.
Methods: An 18
year old gentleman presented with three months of poor sleep. There was no
depressive, manic, psychotic, anxiety or cognitive symptoms. He was
diagnosed with WD three months ago. Physical examination was normal
however Kayser-Fleischer rings were noted. MRI brain demonstrated
symmetrical signal abnormalities noted in the head of the caudate nucleus,
putamen and globus pallidus. His insomnia worsened on increased dose of
chelating agent so the agent was reduced. Longitudinally he developed
depressive symptoms so has been commenced on mirtazapine.
Discussion:
Psychiatric complications of WD are found in initial presentation in 30-67%
cases. Underlying scientific mechanisms proposed include brain copper
toxicity, presynaptic SERT availability, and alternative metabolic influences.
Treatment focuses on chelating agents and psychotropic augmentation.