27th National Clinical Education Symposium Presentation Abstracts

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29 APRIL 2025, MONDAY
13:00-14:00 POSTER PRESENTATION SESSION-2

Psychiatric Comorbidities in Wilson Disease: The Role of Treatment-Resistant Depression in Neurodegeneration

Ecem Şirin Savran1, Gülin Özdamar Ünal1

1. Departmant of Psychiatry, Suleyman Demirel University Research and Education Hospital

DOI: 10.5080/kes27.abs133 Page 159
OBJECTIVE:Wilson disease (WD) is a rare autosomal recessive disorder affecting copper metabolism, primarily manifesting with hepatic, neurological, and psychiatric symptoms. While psychiatric symptoms occur in 10–25% of cases, nearly all patients experience mood disturbances, personality changes, or psychosis at some point during the disease course. CASE (The patient consent must be provided and specified with appropriate terms.):We present the case of a 20-year-old female who was diagnosed with WD in 2015 who exhibited treatment-resistant depressive disorder and multiple suicide attempts. In 2022, she sought medical attention for persistent anxiety and depressive mood. Despite receiving adequate doses and treatment durations of multiple SSRIs (fluoxetine, escitalopram, paroxetine, sertraline) and antipsychotics (olanzapine, risperidone, aripiprazole), her depressive symptoms and self-mutilative behavior persisted, suggesting a treatment-resistant trajectory. In December 2024, she was admitted to our hospital's emergency department following a suicide attempt by medication overdose. During psychiatric evaluation, she reported anhedonia, guilt, and feelings of worthlessness.The patient was hospitalized for 40 days for further evaluation and treatment adjustment in our psychiatry clinic. Physical examination and laboratory findings were largely unremarkable, except for mildly elevated liver function markers (ALT, AST, LDH). She was prescribed duloxetine (60 mg/day) and alprazolam (1 mg/day). On cerebral MRI, supraventricular and parietal cerebral atrophy was observed. However, while her MRI scan from March 2023 was initially normal, subsequent imaging revealed early-onset cerebral atrophy. This suggests that treatment-resistant depressive episodes may have accelerated the neurodegenerative process, leading to structural brain changes earlier than expected. Informed constent was obtained from the patient and her relatives. DISCUSSION:This case highlights the potential role of psychiatric comorbidities, particularly treatment-resistant depression, in accelerating cortical atrophy in WD. Since neurodegenerative changes are usually observed in later stages or untreated cases, the presence of early cerebral atrophy in this patient suggests that severe psychiatric symptoms might contribute to disease progression.