Treatment of neuropsychiatric symptoms in Huntington’s Disease: a retrospective cohort study

Ruben L. Andriessen1, Mayke Oosterloo1, Angelique Hollands1, David E. J. Linden2, Albert F.G. Leentjens3

1. Department of neurology, Maastricht University Medical center, Maastricht, The Netherlands
2. School of Mental Health and Science, Maastricht University, Maastricht, The Netherlands
3. Department of psychiatry, Maastricht University Medical center, Maastricht, The Netherlands 

Much attention is given to treatment of motor symptoms in Huntington’s Disease (HD). On the contrary, less is known about neuropsychiatric symptoms, which occur in 33%-76% of the HD patients and can become manifest even a decade before disease onset.

The aim of our study is to give an overview of the drug types in the treatment of neuropsychiatric symptoms in HD and to describe the most prevalent neuropsychiatric indications for drug prescriptions in different disease stages.
All premanifest and manifest HD patients using medication for neuropsychiatric symptoms were included. Disease stages from premanifest to disease stage 5 were derived from the Total Functional Capacity scores (TFC) and neuropsychiatric medications were regrouped to reflect four main groups of psychopharmaceutic drugs: antidepressants, antipsychotics, anxiolytics and sedatives and anti-epileptics.

Of 5692 eligible participants using medication for neuropsychiatric symptoms, 746 were diagnosed as pre-manifest and 4946 as manifest. In all but the most advanced disease stage antidepressants were the most frequently prescribed drugs. Antidepressant drug prescriptions gradually decrease from 74.1% of the total drug prescriptions in the pre-manifest phase to 27.3% in disease stage 5. On the contrary, as disease stage increases, rates of antipsychotic drug prescriptions increase from 7,0% to 38,7% in the premanifest stage and disease stage 5 respectively. Prescription rates of anxiolytics and sedatives are comparable in all disease stages, slightly increasing in the most advanced stages.

In all disease stages, depression was the main indication for psychopharmaceutic drug prescriptions. In the pre manifest phase, other frequently diagnosed main indications were anxiety, irritability, and paranoid thinking/delusions. Depression (63.0% to 31.5%) and anxiety (30.0% to 15.4%) decrease in more advanced disease stages as main indication for drug prescription in contrast to increasing irritability (3.1% to 28.6%) and paranoid thinking/delusions (0.9% to 16.0%) indications.

The most prescribed drug type for neuropsychiatric symptoms in HD is an antidepressant. However, with advancing disease stages, a reduction in antidepressant and an increase in antipsychotic drug prescriptions is seen. In early-stage HD, depression and anxiety are the most common neuropsychiatric indications for drug prescriptions, in contrast to depression and irritability in more advanced stages.

Keywords
Neuropsychiatric symptoms; psychopharmaceutic drugs