Probability of Obsessive and Compulsive Symptoms in Huntington’s Disease

Huntington’s disease is a disorder that results in motor, cognitive, and psychiatric problems. The symptoms often take different forms and the presence of disturbances of the psychic sphere reduces patients’ autonomy and quality of life, also impacting patients’ social life. It is estimated that a prevalence between 33% and 76% of the main psychiatric syndromes may arise in different phases of the disease, often in atypical form, even 20 years before the onset of chorea and dementia. We present a narrative review of the literature describing the main psychopathological patterns that may be found in Huntington’s disease, searching for a related article in the main database sources (Medline, ISI Web of Knowledge, Scopus, and Medscape). Psychiatric conditions were classified into two main categories: affective and nonaffective disorders/symptoms; and anxiety and neuropsychiatric features such as apathy and irritability. Though the literature is extensive, it is not always convergent, probably due to the high heterogeneity of methods used. We summarize main papers for pathology and sample size, in order to present a synoptic vision of the argument. Since the association between Huntington’s disease and psychiatric symptoms was demonstrated, we argue that the prevalent and more invalidating psychiatric components should be recognized as early as possible during the disease course in order to best address psychopharmacological therapy, improve quality of life, and also reduce burden on caregivers.

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“…The association of PS with HD is a consequence of a relative hyperdopaminergic state (Table 7) [23,24,29,38,40,48,76,77]. …”

Section: Clinical Features In Hd and Psychiatric Disordersmentioning

confidence: 99%

Neuropsychiatric Burden in Huntington’s Disease

et al. 2017

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“…Whether these OC symptoms decreased at the most severe stage of Huntington's disease was not reported. These data suggest a complex aetiological relationship between Huntington's disease and OC symptoms which depends on a time window in disease progress 28. Of note, in those studies investigating OC symptom severity, severity remained at a sub-threshold level at all stages of disease progression (<1 h daily spent on OC behaviour, and only mild distress from OC symptoms) 26–31…”

Section: Resultsmentioning

confidence: 87%

“…In three controlled studies with 1959 patients with Huntington's disease,26 27 29 increased rates of OC symptoms were found both in non-manifest and manifest carriers compared with the general population (27%, 52% and 24%, respectively). Beglinger et al 28 studied a large cohort of 3964 subjects with Huntington's disease with either manifest symptoms (n=3255) or prior to symptom onset (n=709), for the presence of OC symptoms. The subjects showed a maximum of 24.0% obsessions and 12.0% compulsions at stage 4 of the disease according, to Shoulson and Fahn criteria (stage 0 indicating no functional impairment and stage 5 indicating the highest level of disability54), compared with a proportion of 7% for obsessions and 3.5% for compulsions in stage 0.…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, OC symptoms were found to increase with disease severity, with a tendency to decrease at the most severe stage of the disease. Apparently, at this end stage of the disease, cognitive decline results in both a lower accuracy in reporting OC symptoms and a decrease in the cognitively driven obsessions that motivate OC behaviour in these patients 28. The finding that OC symptoms are already present in the pre-manifest stage of Huntington's disease, coupled with the U shape of OC symptom severity related to time to disease onset, suggests that the motor and OC symptoms in Huntington's disease share similar aetiological mechanisms which might be based on similarities in basal ganglia dysfunction coupled with decreased frontal–striatal control.…”

Section: Discussionmentioning

confidence: 97%

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Relationship between movement disorders and obsessive–compulsive disorder: beyond the obsessive–compulsive–tic phenotype. A systematic review

Fibbe

Cath

Heuvel

et al. 2012

J Neurol Neurosurg Psychiatry

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Background Obsessiveecompulsive disorder (OCD) and symptoms (OC symptoms) are associated with tic disorders and share an aetiological relationship. The extent to which OCD/OC symptoms are correlated with other hyperkinetic movement disorders is unclear. The aim of this review was to investigate this co-occurrence and the extent to which OCD/OC symptoms and hyperkinetic movement disorders share a neurobiological basis. Methods A systematic review was performed, specifically searching for OCD/OC symptom comorbidity in hyperkinetic movement disorders using case control studies, longitudinal studies and family based studies. The literature search was conducted using PubMed and PsycINFO databases. Results Heterogeneity of measurement instruments to detect OCD diagnosis and OC symptoms decreased comparability between studies. The most convincing evidence for a relationship was found between the choreas (Huntington's disease and Sydenham's chorea) and OCD/OC symptoms. Furthermore, elevated frequencies of OC symptoms were found in small case control series of dystonias. Small family based studies in dystonia subtypes modestly suggest shared familial/ genetic relationships between OC symptoms and dystonia. Conclusion Current data indicate a relationship between OCD/OC symptoms and the choreas. As OCD and the choreas have been associated with dysfunctional frontalestriatal circuits, the observed relationships might converge at the level of dysfunctions of these circuits. However, paucity of longitudinal and family studies hampers strong conclusions on the nature of the relationship. Implications The relationship between OCD and movement disorders needs further elaboration using larger family based longitudinal studies and sound instruments to characterise OC symptomatology. This could lead to better understanding of the shared pathology between OCD and hyperkinetic movement disorders.

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“…The probability of obsessive and compulsive symptoms, as assessed by the UHDRS, has been measured and shown to increase with disease severity, with a peak of 24% for obsessions and 12% for compulsions in advanced stages of illness [38] . The full criteria for OCD, however, are rarely met [38] .…”

Section: Behavioral and Psychiatric Dysfunctionmentioning

confidence: 99%

Huntington's Disease: Looking Beyond the Movement Disorder

Morreale

2015

Advances in Psychosomatic Medicine

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Although Huntington's disease is classically considered a motor disease, psychiatric, behavioral, and cognitive symptoms are often presenting signs of illness. Even in isolation, these comorbidities can lead to impairment in function and significant distress for patients and their families. Intended for treating psychiatrists, this review discusses the clinical presentation and treatment of Huntington's disease.

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Probability of Obsessive and Compulsive Symptoms in Huntington’s Disease

Cited by 49 publications

References 13 publications

Neuropsychiatric Burden in Huntington’s Disease

Neuropsychiatric Burden in Huntington’s Disease

Relationship between movement disorders and obsessive–compulsive disorder: beyond the obsessive–compulsive–tic phenotype. A systematic review

Huntington's Disease: Looking Beyond the Movement Disorder

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