Saint-Laurent M
Université de Montréal, Québec.
Can J Psychiatry. 1992 Jun;37(5):358-60. doi: 10.1177/070674379203700511.
An 18 year-old male first presented a clinical picture of acute psychosis with two recurrences at ages 22 and 23. The diagnosis made at that time was paranoid schizophrenia. Twelve years after his first psychiatric hospitalization, it was discovered that he was suffering from Wilson's disease. In retrospect, the clinical picture was atypical, notably with an important neurologic involvement mainly parkinsonism almost uncontrollable and aggravated with neuroleptics. The chelating treatment with d-penicillamine resulted in partial improvement of the neurological involvement because the extrapyramidal and neurovegetative symptoms persisted. The psychiatric symptoms improved with fewer neuroleptics than during the 12 previous years. However, neuroleptics had to be continued because of the delay in diagnosing the illness, which diminished the efficiency of the single chelating treatment. The clinical presentation and therapeutic response of this patient strongly suggest a link between the cerebral intoxication by copper and the psychiatric symptoms.
一名18岁男性首次出现急性精神病临床表现,分别在22岁和23岁时复发两次。当时诊断为偏执型精神分裂症。首次精神科住院12年后,发现他患有威尔逊病。回顾来看,临床表现不典型,尤其是有明显的神经受累,主要是几乎无法控制的帕金森症,且使用抗精神病药物后病情加重。用青霉胺进行螯合治疗使神经受累部分改善,因为锥体外系和植物神经症状持续存在。与之前12年相比,使用较少的抗精神病药物后精神症状有所改善。然而,由于疾病诊断延迟,单一螯合治疗效果降低,仍需继续使用抗精神病药物。该患者的临床表现和治疗反应强烈提示铜所致脑中毒与精神症状之间存在联系。