Jrpbs.com Original Article Journal of Research in Psychiatry and Behavioral Sciences/ Vol. 1/ Issue 1/ July-December, 2015 Page 17 A CASE SERIES OF WILSON’S DISEASE PRESENTING WITH PSYCHIATRIC MANIFESTATIONS Suddhendu Chakraborty 1 , Debashis Sanyal 2 , Nabanita Bannerjee 3 1 Senior Medical Officer, Department of Psychiatry, KPC Medical College and Hospital. 2 Professor, Department of Psychiatry, KPC Medical College and Hospital. 3 Clinical Psychologist, Department of Psychiatry, Aswini Datta Memorial College. ABSTRACT BACKGROUND Wilson’s disease is an autonomic recessive disorder of copper metabolism resulting from the absence or dysfunction of a copper transporting P type ATPase encoded on chromosome 13. Neuropsychiatric signs have been found to be the first presenting symptom of Wilson’s in 40% to 50% of the cases. THE CASE SERIES In this case series we have described 5 diagnosed case of Wilson’s where neuropsychiatric manifestations where the first presenting symptom. Most common presenting symptom was low mood with psychomotor retardation and depressive cognition. Selective Serotonergic Reuptake Inhibitors proved to be fairly effective in most of the cases. Most of the cases had a fairly satisfactory psychiatric prognosis and acceptable recovery though there was initial worsening of the neurological signs and symptoms. CONCLUSION Study of neuropsychiatric manifestations in Wilson’s disease may prove to be an important therapeutic and diagnostic tool. Moreover, neuropsychiatric manifestation as the first presenting symptom of Wilson’s may throw light in studyi ng the disease semiology. Role of Selective Serotonergic Reuptake Inhibitors (SSRIs) may be implicated to be effective in treatment of the psychiatric manifestations. KEYWORDS Wilson’s, Neuropsychiatric; Symptoms. HOW TO CITE THIS ARTICLE: Chakraborty S, Sanyal D, Bannerjee N. “A case series of wilson’s disease presenting with psychiatric manifestations.” Journal of Research in Psychiatry and Behavioral Sciences 2015; Vol. 1, Issue 1, July-December 2015; Page: 17-20. INTRODUCTION Wilson’s disease is an autonomic recessive disorder of copper metabolism resulting from the absence or dysfunction of a copper transporting P type ATPase encoded on chromosome 13.Wilson’s commonly present with hepatic manifestations (Like chronic hepatitis, asymptomatic cirrhosis or acute liver failure) and neuropsychiatric symptoms like dystonia. 1 tremor, personality changes and cognitive impairments secondary to copper accumulation in the Central Nervous System. 2 Occurrence of psychiatric manifestations in Wilson’s have been time tested. 3 There has been extensive research regarding first possible neuropsychiatric manifestation of Wilson’s. Mania, psychosis and behavioural disturbances have been found in a few researches to be the first presenting symptom. Neuropsychiatric signs have been found to be the first presenting symptom of Wilson’s in 40% to 50% of the cases. 4,5,6 There has been a research that has shown reversal of the neuropsychiatric manifestations to a certain extent following successful liver transplantation in a few cases of Wilson’s disease. 7,8 Financial or Other, Competing Interest: None. Submission 04-12-2015, Peer Review 05-12-2015, Acceptance 15-12-2015, Published 21-12-2015. Corresponding Author: Dr. Suddhendu Chakraborty, 30B, Second Road, East End Park, Kalikapur, Kolkata-700099. E-mail: dr.suddhenduchakraborty@gmail.com In this case series we have described 5 diagnosed case of Wilson’s where neuropsychiatric manifestations where the first presenting symptom. Most common presenting symptom was low mood with psychomotor retardation and depressive cognition. Selective Serotonergic Reuptake Inhibitors proved to be fairly effective in most of the cases. Most of the cases had a fairly satisfactory psychiatric prognosis and acceptable recovery. THE CASE SERIES The series consisted of five diagnosed case of Wilson’s disease. The study was conducted in Calcutta National Medical College Neurology Clinic over a period of 2 years which included a 1 year follow up period. They were diagnosed mainly on the basis of elevated 24 hour urinary copper levels, reduced serum ceruloplasmin levels and a positive Kayser Fleischer Ring on slit lamp ophthalmological examination of the eyes. All over 14 cases of suspected Wilson’s disease were chosen for the study. Of the patient shortlisted, most of the cases seemed to belong to the 12-17 years age group (3 cases), one belonged to the 4-11 years age group and another in adult age group (Greater than 18 years age group). However none were more than 19 years of age. Most of the cases were females (4 out 5). Most of them belonged to Kolkata and the suburban (4 out of 5) and only one came from outside. Most were Muslims (4 out of 5) and 1 belonged to Hinduism. The cases mostly presented with neuropsychiatric symptoms like reduced sleep (80%), reduced appetite (60%),