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

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.