title: Mania as the first manifestation of Wilson's disease.
abstract: BACKGROUND
  Although mental changes are frequent in Wilson's disease, severe psychiatric disorders occur uncommonly and usually accompany the neurological picture. There are few reports in the literature of Wilson's disease patients with typical bipolar affective disorder (BPAD).
  
  
  METHODS
  The authors report the case of a patient with Wilson's disease whose initial manifestation was a manic episode followed by depression. Tremor in the upper limbs appeared one year after the onset of symptoms. The diagnosis of Wilson's disease was established three years after the first symptoms appeared, based on the neuropsychiatric picture, the detection of Kayser-Fleischer rings and the results of diagnostic tests indicating chronic liver disease and copper excess. ATP7B genotyping and magnetic resonance imaging of the brain with proton spectroscopy study were also performed. The patient became asymptomatic two years after starting treatment with penicillamine and remained non-symptomatic controlled during the eight-year follow-up period, without any specific treatment for the BPAD.
  
  
  CONCLUSIONS
  To our knowledge, this is a singular report of a case of Wilson's disease in which a manic episode preceded the onset of neurological symptoms. The association between Wilson's disease and bipolar disorder is discussed.
authors.affiliation: Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Alexandre Costa
authors.initials: AC
authors.lastname: Machado
authors.forename: Marta Mitiko
authors.initials: MM
authors.lastname: Deguti
authors.forename: Leonardo
authors.initials: L
authors.lastname: Caixeta
authors.forename: Mariana
authors.initials: M
authors.lastname: Spitz
authors.forename: Leandro Tavares
authors.initials: LT
authors.lastname: Lucato
authors.forename: Egberto Reis
authors.initials: ER
authors.lastname: Barbosa
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000209:etiology*; D006527:Hepatolenticular Degeneration / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male