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

Received September 20, 2000; revised January 5, 2001; accepted January 10, 2001. From the Institute of Psychiatry, School of Medicine, University of São Paulo, Brazil. Address correspondence requests to Dr. Matarazzo, Departamento de Psiquiatria, Faculdade de Medicina, USP, Caixa Postal 3671, São Paulo, SP, Brazil. E-mail: eneidam_br{at}yahoo.com.br

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.

Key Words: Wilson's Disease • Diagnosis • Circadian Rhythms

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