Treatment of Wilson's Disease in Patients with Psychosis or Hallucinations

Wilson's disease can present with psychiatric manifestations, including psychosis and hallucinations. When these symptoms occur, pharmacological management requires careful agent selection to address the psychiatric presentation while accounting for the underlying condition.

Clinical Scenario

This protocol covers Wilson's disease in the specific setting of psychosis or hallucinations. The clinical goal is improvement or resolution of these psychiatric symptoms, with particular attention to the safety profile of any chosen therapy in this patient population.

Treatment Approach — Partial Overview

First-line management is built around a class of antipsychotics selected specifically for their favourable extrapyramidal and hepatic risk profile. Structured guidance identifies which agents are appropriate first-line, which should be reserved for the most severe or treatment-resistant cases, and which must be avoided in this population.

Full agent selection, sequencing, and clinical decision points are in the complete protocol.

Treatment target: Improvement or resolution of psychosis and hallucinations.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2024.11.007

Quetiapine and clozapine are neuroleptics associated with low risk of extrapyramidal symptoms, as well as low hepatic risk, and could be recommended as the first-line treatment for psychosis.

However, clozapine should be reserved for the most severe and treatment-resistant cases due to increased risk of leukopenia.

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