Fast Five Quiz: Schizophrenia Differential Diagnosis

Stephen Soreff, MD


August 11, 2020

Wilson disease, also known as "hepatolenticular degeneration," is a disorder of the metabolism of copper. It is an autosomal recessive illness. The first psychiatric symptoms are often vague changes in behavior during adolescence. It is primarily a liver disease.

Laboratory findings include increased urinary levels of copper and low serum levels of copper and ceruloplasmin. Kayser-Fleischer rings (copper deposits around the cornea) can sometimes be seen. The diagnosis is usually confirmed by finding increased hepatic copper at biopsy.

Porphyrias are disorders of heme biosynthesis. Acute intermittent porphyria can present with psychiatric symptoms. Patients may have a family history of psychosis. The psychiatric symptoms may be associated with electrolyte changes, peripheral neuropathy, and episodic severe abdominal pain. Abnormally high levels of porphyrins in a 24-hour urine collection confirm the diagnosis.

Patients with hypoxemia or electrolyte disturbances may present with confusion and psychotic symptoms. Hypoglycemia or hyperglycemia can produce confusion and irritability and may be mistaken for psychosis.

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