title: Psychiatric aspects of Wilson disease: a review.
abstract: OBJECTIVE
  To review the current evidence about psychiatric symptoms in Wilson's disease (WD).
  
  
  METHODS
  We searched Ovid, PsychInfo, CINHAL and PubMed databases from May 1946 to May 2012 using the key words Wilson('s) disease in combination with psychiatry, psychiatric, psychosis, schizophrenia, depression, mania, bipolar, mood, anxiety, personality and behavior.
  
  
  RESULTS
  Psychiatric symptoms occur before, concurrent with or after the diagnosis and treatment for WD. Thirty to forty percent of patients have psychiatric manifestations at the time of diagnosis, and 20% had seen a psychiatrist prior to their WD diagnosis. When psychiatric symptoms preceded neurological or hepatic involvement, the average time between the psychiatric symptoms and the diagnosis of WD was 864.3 days. The prevalence of psychiatric disorders in WD patients varies wildly (major depressive disorder, 4-47%; psychosis, 1.4-11.3%). Certain gene mutations of ATP7B may correlate with specific personality traits.
  
  
  CONCLUSIONS
  Psychiatric manifestations represent a significant part of the clinical presentation of WD and can present at any point in the course of the illness. Psychiatric manifestations occurring without overt hepatic or neurologic involvement may lead to misdiagnosis. A better understanding of the psychiatric presentations in WD may provide insights into the underlying mechanisms of psychiatric disorders.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT; Wilson Disease Centers of Excellence at Yale University, New Haven, CT. Electronic address: paula.zimbrean@yale.edu.
authors.forename: Paula C
authors.initials: PC
authors.lastname: Zimbrean
authors.affiliation: Wilson Disease Centers of Excellence at Yale University, New Haven, CT; Section of Digestive Disease and Transplant and Immunology, Yale University School of Medicine; Yale Transplantation Center, Yale New Haven Hospital, New Haven, CT.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schilsky
mesh_terms: D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology; D006527:Hepatolenticular Degeneration / Q000150:complications / Q000235:genetics / Q000523:psychology*; D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000235:genetics / Q000523:psychology*; D010554:Personality Disorders / Q000209:etiology / Q000235:genetics / Q000523:psychology; D011618:Psychotic Disorders / Q000209:etiology / Q000523:psychology; D012559:Schizophrenia / Q000209:etiology; D012565:Schizophrenic Psychology
keywords: Ceruloplasmin; Copper; Psychiatry; Schizophrenia; Wilson's disease