Neuropsychiatric Manifestations of Huntington‘s Disease: A Case Report

Introduction Huntington‘s disease is a rare hereditary neurodegenerative disorder characterised by a triad of motor, cognitive and neuropsychiatric symptoms with the latter two often manifesting first [1,2]. Case Presentation A 49-year-old woman presented with unspecified anxiety with a family history of neurological disease. Her mental state began to decline 2 years ago with mood disturbances, irritability, frequent anger outbursts, anxiety and depressive symptoms. Initially diagnosed with mixed anxiety-depressive disorder patient was treated with Escitalopram 5 mg, Carbamazepine 100 mg and Bromazepam 3 mg. During the last 6 months, she developed dizziness, increased distractibility, memory impairments and difficulty navigating at home. During examination involuntary chorea-like hand movements were observed. Diagnosed with unspecified anxiety disorder the patient was treated with Tiapride 100 mg and later with Risperidone 3 mg due to developing delusions of persecution, harm and poisoning. Due to persistent anxious behaviour, involuntary chorea, cognitive-decline, worsening delusions, aggression, she was referred for inpatient treatment. Following a reduction in psychotic symptoms, patient was discharged. Genetic consultation confirmed Huntington’s disease with changes in HTT gene's first exon indicating CAG repeat expansion. Unspecified anxiety disorder diagnosis was changed to anxiety disorder due to known physiological condition. Discussion Huntington’s disease can initially present with neuropsychiatric symptoms – depressive symptoms (9-63%), anxiety (13-71%), irritability (38-73%), aggression (22-66%), psychotic symptoms (9-17%) which along with / or cognitive symptoms can precede motor symptoms in about 42% of patients [1–4]. In this case, the patient's mental decline (depressive symptoms, anxiety, irritability, aggression, cognitive symptoms) preceded motor symptoms, reminding the need to recognise neuropsychiatric symptoms as potential indicators of Huntington's disease. Moreover, the patient experienced psychotic symptoms, a less common neuropsychiatric manifestation of Huntington’s disease [3–5]. Conclusions This case emphasises the need to explore organic causes in patients with unexplained neuropsychiatric symptoms, especially if there is a family history of neurological disease.