Penicillamine Therapy for Schizophreniform Psychosis in Wilson's Disease

A hospitalized 22-year-old woman had suffered from Wilson's disease for the past 11 years. The diagnosis was confirmed by hepatic nonspecific changes, high copper urine excretion, and low to zero serum ceruloplasmin, but psychiatric symptomatology was the main manifestation of the disease. The history of treatment modalities and a controlled trial with penicillamine revealed a clear priority of this drug over phenothiazines in abolishing the psychotic features of the disease. The effective dose in this case was found to be over 1650 mg/day. The mental state, as measured by the Brief Psychiatric Rating Scale, was clearly correlated to the dose of penicillamine. In addition, there was a tendency to increased copper excretion with penicillamine treatment. This case suggests a connection between copper brain poisoning and the related acute psychotic features, which responded well to penicillamine treatment.