Huntington Disease Versus Schizophrenia-Like Psychotic Symptoms

Huntington’s disease (HD) is named after an American physician George Huntington in seventeen century, 1872 who contributed to a description of clinical features of the neurodegenerative disease. It is an autonomic dominant adult onset genetic disorder in which there is genetic mutation at the short arm of chromosome 4, whereby it consist of expansion of repeated CAG in the gene IT15 contribute to 36 or more CAG repeats on this gene as compare to healthy individuals that have only 11-35 CAG repeats (Corrêa, Xavier & Guimarães, 2006). HD’s triad of clinical presentations are cognitive decline, choreic movements and psychiatric manifestation.

The symptoms presented most often between ages 35 to 50. In HD only the brain is affected, other organs are spare. In comparison with other neurodegenerative disease such as Alzheimer and Parkinson’s disease, affected individual with HD are usually younger with less medical comorbidities (Huntington'’s Disease Society of America, 2014). The onset of HD seems to get earlier in succeeding generations, which is called “anticipation. ” The life span are around 10 to 20 years after onset of HD and finally the individual might passed away due to medical complications such as pneumonia or traumatic complication such as subdural hematoma, infections, malnutrition or cachexia due to dysphagia etc (Folstein, Leigh, Parhad & Folstein, 1986). The prodromal period of HD might presented with non-specific psychiatric syndromes leading to diagnosis confusion. Psychiatric manifestation such as schizophrenia-like psychosis, depression and personality disorder can precede, accompany or after the neuronal symptoms (Shiwach, 1994).

There were 2 studies in United Stated demonstrated that depression can be the early sign of HD that occurred before the presentation of chorea- form movement disorder by years. The prevalence of depression among HD individual is 39% associated with four to six fold increase in suicide. Personality and behavioural changes are varied in time of manifestation in the course of the disease. Almost every individual with HD will shows apathy, aggressive, irritability as well as violent behaviour. The prevalence of HD individual presented with schizophrenic-like psychosis is estimated around 6 to 25%. The paranoid and delusional form are the most common type reported. In referring to Mr SO, he had presented with conduct type of behavioral problems along with sudden onset of schizophrenia –like psychosis and history of substance abused in the young age has confused the diagnosis of Substance induce psychosis and Schizophrenia with comorbid substance abused in the first few admissions to the psychiatry ward.

The manifestation of choreic movement was approximately three to four years after the onset of behavioral problem. As Mr SO’s family could not be traced for the first few admissions to Hospital Tuanku Fauziah. Thus, the positive family history of HD only came to light during current admission to ward where via the help from the department of social welfare finally connected to his daughter but at that point of time Mr SO’s already manifested with Choreic form movement. Based on (Huntington's Disease Society of America, 2014) every individual that carry the abnormal gene will eventually develop symptoms of HD unless they passed away prematurely of some other illness or accident. On top of that, about 5-10% of the individuals with HD not aware of their affected parent, thus there is possibility that Mr SO ‘s father would have passed away prematurely before being diagnosed HD and he might be the first person in the family to have developed the behavioural problem before diagnosed HD 3 to 4 years later.