Psychiatric Features and Disturbance of Circadian Rhythm of Temperature, Pulse, and Blood Pressure in Wilson's Disease

Wilson's disease (hepatolenticular degeneration), a disease of genetic origin, is due to abnormal copper metabolism affecting many organs and systems, especially the liver and the nervous system. The initial symptoms can be exclusively or predominantly psychiatric, including psychotic features. Three cases are reported in which the clinical picture at the beginning was compatible with a psychiatric diagnosis. During hospitalization, before treatment, there were abnormal and spontaneous changes in the circadian rhythm of temperature, pulse, and blood pressure, recorded every 6 hours, with febrile peaks in the absence of infectious focus. Because the hypothalamus is important in the regulation of these autonomic functions, the hypothesis of a possible hypothalamic dysfunction was made, justifying a wide clinical and laboratory investigation that allowed the diagnosis of Wilson's disease. Alertness to circadian rhythm abnormalities in such cases may help the psychiatrist avoid an erroneous diagnosis.