Wilson′s disease Presenting with Neuropsychiatric Manifestations.

2003) about a child with Wilson's disease presenting with psychotic symptoms. We report a similar case of Wilson's disease presenting with neurological and psychotic symptoms. She is being presented due to the later age of onset of the disorder as well as the presence of psychotic symptoms which is present in only 20 % of patients with Wilson's disease (Lishman, 1998) A 19 year old girl presented to us with a nine months history of abnormal movements of her hands on performing a task,abnormal neck movements and difficulty in walking. She also had a one month history of hearing voices,suspiciousness that people were talking ill of her and persecuting her.She also had decreased sleep associated with decline in scholastic performance and social functioning.. Her abnormal movements had worsened after her psychotic symptoms had appeared. There was history of one episode of jaundice two years back.There was no family history of a neurological or psychiatric illness. She was treated elsewhere initially as a functional psychotic illness with antipsychotics with minimal improvement. Due to the worsening of symptoms, she was referred to our hospital. On examination, she had wing beat tremors of her hands, titubation involving her neck muscles, intentional tremor, and scanning speech synchronous with every beat of the tremor. These abnormal movements were absent at rest. Abdominal palpation revealed hepatomegaly. Ocular examination revealed a K-F ring. Mental Status examination revealed intact primary mental functions, content of thought revealed persecutory and referential delusions with third person auditory hallucinations which were fleeting and derogatory in content.Mood was irritable Wilson's disease presenting with neuropsychiatric manifestations. and labile. Investigations showed low serum ceruloplasmin , increased 24 hour urine copper and increased serum copper. MRI Brain showed atrophy of the lentiform nucleus, dilatation of the lateral ventricle and cerebellar atrophy. Renal and hepatic functions were within normal limits. An Arterial Blood Gas analysis did not show any Renal Tubular Acidosis. In view of this,a diagnosis of Wilson's disease was considered and she was started on D-Pencillamine and Pyridoxine. She was also started on Tab. Risperidone for her psychotic symptoms which was increased to 4 mg at discharge with no adverse effects. There was a marginal improvement in her abnormal movements at discharge while the psychotic symptoms gradually reduced. She has been following up regularly at our outpatient clinic. Screening for Wilson's disease was also advised for her younger sister. She is being presented to highlight …