Author information

• ¹Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT; Gastroenterology and Hepatology, Royal Surrey County Hospital, Surrey, United Kingdom.
• ²Gastroenterology and Hepatology, Royal Surrey County Hospital, Surrey, United Kingdom; Department of Clinical and Experimental Medicine, University of Surrey, Surrey, United Kingdom; King's College Hospital, Institute of Liver Studies, London, United Kingdom.
• ³Digestive Diseases, Transplantation and Immunology, Yale University, New Haven, CT.
• ⁴Yale Center for Analytical Sciences, Yale University, New Haven, CT.
• ⁵Advent Health Transplant Institute, Orlando, FL.
• ⁶Neurology, Yale University, New Haven, CT.
• ⁷Psychiatry, Yale University, New Haven, CT.
• ⁸Psychiatry, Yale University, New Haven, CT. Electronic address: paula.zimbrean@yale.edu.

Abstract

Background and aims: Psychiatric symptoms are frequently reported in Wilson disease (WD); however, systematic assessments with validated measures are lacking.

Objective: We aim to report the prevalence and clinical correlates for major depressive disorder (MDD) as resulting from a multisite international WD registry.

Methods: All patients enrolled in the WD registry received structured psychiatric evaluations (Mini International Neuropsychiatric Interview, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, Perceived Stress Scale), laboratory tests, hepatology, and neurological assessments. We present the analysis of the data collected at enrollment for the first 3 years (N = 62).

Results: Thirty-seven percent (23) had a lifetime history (MDD), and 6% (4) met the criteria for an active major depressive episode. Depression was self-reported in 30.51% (19) at WD diagnosis. Patients with MDD had worse mental health quality-of-life (QOL) scores (median 43 vs 53.6, P = 0.006), higher severe anxiety (13.04% vs 0), higher perceived stress (median 18 vs 9, P < 0.003), and higher levels of neuroticism (median 8 vs 5.0, P = 0.002). We found no significant difference in physical health QOL and severity of neurological or liver disease. There was no significant difference in copper parameters or liver tests in those with MDD and without. The limitations of our study consist of the small sample size, the cross-sectional report, and the lack of brain copper measurements.

Conclusions: Lifetime MDD is highly prevalent in WD and associated with worse mental health QOL. We did not find a significant association among liver disease, neurological disease laboratory tests, and MDD. Screening for depression should be considered in patients with WD.