Management of Wilson Disease by Michael L. Schilsky

Author:Michael L. Schilsky
Language: eng
Format: epub
ISBN: 9783319915272
Publisher: Springer International Publishing

Bipolar Disorders and Bipolar Spectrum

Bipolar presentations can vary from a full manic episode (which includes abnormally and persistently elevated, expansive, or irritable mood, persistently increased goal-directed activity or energy, inflated self-esteem or grandiosity, decreased need for sleep, more talkative or pressure to keep talking, flight of ideas or subjective racing thoughts, distractibility, increase in goal-directed activity activities with high potential for bad consequences and last for at least a week) to various degrees of mood instability or impulsivity. Prevalence of bipolar disorder in patients with WD varies between 18% and 39% [41]. In addition to formally diagnosed bipolar disorders , patients with WD may present with various degree of mood instability that may not meet criteria for mania or hypomania but may significantly impact the quality of life [9, 45].

It is also important to know that WD patients may present at various points in their lives with behavioral changes that do not meet criteria for specific psychiatric disease [46]: irritability (prevalence 15–25%) [47, 48], impaired social judgment or disinhibition [9, 48], apathy [48], “belligerence” [9], or “incongruent behavior” [47]. Personality changes are described in up to 57% of patients with WD [8, 47].

Differentiating psychiatric symptoms in WD from an underlying primary psychiatric disorder is extremely challenging. Features that point toward psychiatric symptoms being secondary to WD are coexistence between psychiatric symptoms and neurological or liver disease, abrupt onset of psychiatric symptoms, psychiatric symptoms not meeting the criteria for common DSM-5 syndromes, and evidence of laboratory or brain imaging abnormalities. Distinguishing between primary psychiatric disease and psychiatric symptoms secondary to WD may guide the length of treatment as we will discuss below.

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