B-20: Neuropsychological Evaluation of Pediatric Wilson’s Disease With Co-Occurring Psychiatric Conditions: A Case Report

Abstract

Objective: Neuropsychological outcomes in pediatric Wilson’s Disease (WD) are not well documented, particularly with co-occurring psychiatric symptoms. This case study discusses symptoms and neuropsychological outcomes in an adolescent with WD and psychiatric diagnoses. Method/Data Selection: JM is a 14-year-old, English-speaking, White female with genetically confirmed WD (ATP7B). This was JM’s first neuropsychological evaluation. Prior medical history was unremarkable. She was diagnosed with WD at 11-years-old following psychiatric presentation; zinc supplementation improved copper levels. JM was subsequently diagnosed with FNSD, DID, GAD, and PANDAS. Referral concerns included memory, attention, and academic difficulties. Results/Data Synthesis: JM demonstrated broadly average skills. Parent-rated executive function varied, with age-expected inhibition and self-monitoring, and clinically significant concerns in all other executive functions. Visual attention was average while auditory attention was below average. Immediate (exceptionally low to average visual, low average list-learning) and delayed memory (average list and picture memory, exceptionally low object memory) were variable. List recognition was high average. Parent questionnaires endorsed clinically significant social-emotional and mood concerns. Conclusions: JM’s initial presentation of WD was psychiatric in nature, which persisted after treatment. Individuals with functional/dissociative symptoms often experience memory difficulties. It is possible that WD was a catalyst for underlying psychiatric symptoms, consistent with theoretical models in other syndromes (e.g., diathesis-stress model in schizophrenia; PNES in epilepsy). Psychiatric symptoms may present, or exacerbate, cognitive symptoms; therefore, a comprehensive neuropsychological evaluation is recommended to parse cognitive differences from co-occurring psychosis. Future work is needed to clarify neurocognitive phenotypes and intervention recommendations for pediatric WD.