Neuropsychiatric Symptoms in Huntington Disease: A 5-Question Quiz

Discussion: For chronic agitation associated with recurrent, ongoing distress, or continuing threat of harm to self or others, pharmacologic options include either an antipsychotic or a mood-stabilizing antiepileptic drug. A benzodiazepine may be considered for acute agitation that does not respond to behavioral strategies; however, the long-term use of benzodiazepines should be avoided in ambulatory persons with HD.¹

Discussion: An SSRI is the preferred pharmacologic agent for anxiety that occurs as an isolated symptom or is accompanied by depression or obsessive perseverative behaviors.¹

Discussion: An antidepressant is first-line pharmacologic therapy when it is difficult to distinguish apathy associated with HD from the apathy of depression. Apathy in HD must also be differentiated from the impaired ability of the patient to perform motor or cognitive tasks as a result of the disease itself.¹

Discussion: Psychotic symptoms may occur in patients with HD because of infections, metabolic disorders, substance use, or other medical causes of psychosis or delirium. In addition, consider co-morbid schizophrenia spectrum or mood disorders with psychotic features in the differential diagnosis.¹

Discussion: Sedating antidepressants and sedating neuroleptics are recommended pharmacologic options for treating sleep disorders in HD. Consider melatonin in patients with circadian rhythm disorders. Avoid benzodiazepines in ambulatory individuals, unless all other options have failed.¹