Back to table of contents Previous article Next article LettersFull AccessAripiprazole Treatment for Choreoathetoid and Psychotic Symptoms of Huntington’s DiseaseK.F. Yavuz, M.D., S. Ulusoy, M.D., and İ. Alnıak, M.D.K.F. YavuzSearch for more papers by this author, M.D., S. UlusoySearch for more papers by this author, M.D., and İ. AlnıakSearch for more papers by this author, M.D.Published Online:1 Apr 2013https://doi.org/10.1176/appi.neuropsych.12040097AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: In this case report, we are presenting a 50-year-old man who has Huntington’s disease with choreoathetoid and psychotic symptoms. After 16 months of initial aripiprazole treatment, our patient showed significant progress with chorea and psychosis.Huntington's disease (HD), caused by CAG trinucleotide repeat expansion in the IT15 gene located on the short arm of chromosome 4; is an autosomal dominant, progressive, neurodegenerative disorder, characterized by motor, cognitive, and psychopathological symptoms.1 In this letter, we report a case of a male patient with HD with psychotic symptoms in whom aripiprazole effectively controlled these psychotic symptoms and involuntary movements.Case ReportThe patient, a 50-year-old man diagnosed 20 years previously with HD, first complained about tremor in the extremities and, in time, involuntary movements of the extremities and the body; gait difficulties and dysphagia added to his clinical presentation. He partially benefited from quetiapine 300 mg/day and clonazepam 2 mg/day during the last 1.5-year period. For the last 2 months, he has had insomnia, aggression, self-destructive behaviors, suicidal thoughts, and persecutory delusions, and his relatives took him to our outpatient clinic. On admission to our department, he scored 56 point on Unified Huntington’s Disease Rating Scale (UHDRS) motor section (oculomotor function, 12; hyperkinesias, 22; fine motor tasks, 9; parkinsonism, 4; gait, 9). We started aripiprazole treatment and gradually titrated up to 30 mg/day. In the first month of the treatment, we confirmed that irritability and persecutory delusions were markedly improved; his choreiform movements decreased significantly; and he finally became able to satisfy his own daily needs. At the end of the 16-month follow-up, we evaluated that his personal hygiene was significantly improved; dysarthria and dysphagia were completely ameliorated; and the intension and amplitude of choreiform movements were decreased. The patient still had no psychotic symptoms. We assessed that the last UHDRS total motor score was 20 (oculomotor function, 4; hyperkinesias, 6; fine motor tasks, 2; parkinsonism, 2; gait, 6).DiscussionHD is explained by the loss of the striatal cells, caused by degeneration and apoptosis2 and their dysfunction,3 which are made sensitive to glutamate and dopamine by mutant huntingtin protein. In this respect, the dopamine receptor-antagonist drugs may purport to be useful in treatment of HD. Aripiprazole, as an antipsychotic agent, acts as a partial agonist and affects psychotic symptoms by blocking mesolimbic dopaminergic neurotransmission, while rarely inducing extrapyramidal side effects, by reducing the antagonist load at the nigrostriatal pathway with selective D2 ligand and 5HT2A receptor antagonism.4 Our case report supports the idea that aripiprazole is an effective and safe agent in HD, especially HD with psychotic symptoms.Bakirkoy Mazhar Osman Psychiatry and Neurology Education and Research Hospital, 5th Psychiatry Clinic, Istanbul, TurkeyCorrespondence: Dr. Fatih Yavuz; e-mail: [email protected]comThis work was a Poster Presentation at the 4th International Congress on Psychopharmacology, Antalya, Turkey, November 23–27, 2011.References1 Walker FO: Huntington’s disease. Lancet 2007; 369:218–228Crossref, Medline, Google Scholar2 Paoletti P, Vila I, Rifé M, et al.: Dopaminergic and glutamatergic signaling crosstalk in Huntington’s disease neurodegeneration: the role of p25/cyclin-dependent kinase 5. J Neurosci 2008; 28:10090–10101Crossref, Medline, Google Scholar3 Cepeda C, Wu N, André VM, et al.: The corticostriatal pathway in Huntington’s disease. Prog Neurobiol 2007; 81:253–271Crossref, Medline, Google Scholar4 Naber D, Lambert M: Aripiprazole: a new atypical antipsychotic with a different pharmacological mechanism. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:1213–1219Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byPsychopharmacotherapy in Patients with Tics and Other Motor Disorders5 November 2022State-of-the-art pharmacological approaches to reduce chorea in Huntington’s disease8 February 2021 | Expert Opinion on Pharmacotherapy, Vol. 22, No. 8Psychopharmacotherapy in Patients with Tics and Other Motor Disorders28 December 2019Frontiers in Neurology, Vol. 10Psychiatric Management of Huntington's DiseasePsychiatric Annals, Vol. 47, No. 5Medical management of motor manifestations of Huntington diseaseExpert Review of Neurotherapeutics, Vol. 17, No. 3Movement Disorders, Vol. 29, No. 11 Volume 25Issue 2 Spring 2013Pages E31-E31 Metrics This work was a Poster Presentation at the 4th International Congress on Psychopharmacology, Antalya, Turkey, November 23–27, 2011.PDF download History Published online 1 April 2013 Published in print 1 April 2013
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