Psychosis in Huntington's disease: A systematic review of case reports

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-09-26 DOI:10.1016/j.genhosppsych.2025.09.008

Aliu Opeyemi Yakubu , Oluwakemi Eunice Olalude , Olorungbami Kolade Anifalaje , Moses Gregory Effiong , Francess Oluwaferanmi Adeyemi , Maryam Abubakar

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Abstract

Background

Huntington's disease (HD) is a neurodegenerative disorder characterized by motor, cognitive, and psychiatric symptoms. Psychosis is an uncommon but debilitating psychiatric manifestation in HD. This systematic review synthesizes published case reports to characterize the clinical presentation and management of psychosis in HD.

Methods

We searched the literature for case reports (including small case series) of HD patients with psychosis. Eligible publications (English, 1980–2024) were reviewed, and data on demographics, HD onset, timing of psychosis, family history, psychotic symptomatology, treatments, and outcomes were extracted.

Results

Forty-eight case reports, encompassing 55 HD patients with psychosis. The mean age of psychosis is lower than the mean age of HD diagnosis and motor symptom onset. Psychosis in HD typically presents delusions and hallucinations. Nearly all patients were treated with antipsychotics, predominantly atypical agents; only a few received first-generation antipsychotics. Most patients showed good responses to medication. Common adverse effects of antipsychotics included extrapyramidal symptoms and sedation. Nine reports (13 patients) described the use of ECT for severe or refractory psychosis, with the majority achieving significant reduction in psychotic symptoms and only minimal side effects.

Conclusions

Psychosis in HD can manifest across a wide spectrum of ages and disease stages. Atypical antipsychotics are generally effective for symptom control, and ECT appears to be a safe and effective adjunct for refractory cases. Clinicians should be vigilant for psychosis as a potential early sign of HD and consider a tailored, multidisciplinary treatment approach. Further research is needed to guide management.

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亨廷顿氏病的精神病：对病例报告的系统回顾

背景：亨廷顿氏病（HD）是一种以运动、认知和精神症状为特征的神经退行性疾病。精神病是一种罕见但使人衰弱的HD精神表现。本系统综述综合了已发表的病例报告，以描述HD患者精神病的临床表现和管理。方法：检索文献中HD合并精神病患者的病例报告（包括小病例系列）。我们回顾了符合条件的出版物（英文，1980-2024），并提取了人口统计学、HD发病、精神病发病时间、家族史、精神病症状学、治疗和结果的数据。结果48例报告，其中55例伴有精神病。精神病的平均年龄低于HD诊断和运动症状出现的平均年龄。HD患者的精神病典型表现为妄想和幻觉。几乎所有患者都接受抗精神病药物治疗，主要是非典型药物；只有少数人服用了第一代抗精神病药物。大多数患者对药物治疗反应良好。抗精神病药物常见的不良反应包括锥体外系症状和镇静。9份报告（13例患者）描述了使用电痉挛疗法治疗严重或难治性精神病，大多数患者的精神病症状显著减轻，副作用极小。结论HD患者的精神病可以表现在广泛的年龄和疾病阶段。非典型抗精神病药物通常对症状控制有效，ECT似乎是一种安全有效的辅助治疗难治性病例。临床医生应该警惕精神病作为HD的潜在早期症状，并考虑量身定制的多学科治疗方法。需要进一步的研究来指导管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

期刊介绍： General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.