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Background The clinical manifestations of Huntington’s disease (HD) also include psychiatric disturbances, as well as motor and cognitive disorders. Estimated rates for lifetime prevalence of psychiatric disorders among HD patients vary between 33% and 76%. Tetrabenazine is considered the first line treatment for motor disturbances in absences of some psychiatric contraindication (suicide risk). The current literature on the psychopharmacological treatment lack of a large randomised controlled trial, however many small case series are available. Aims We present a review of the literature describing treatments of psychiatric manifestation in HD, focusing on specific disturbances and the role of polytherapy. Methods A search in the main database sources (Medline, Isi Web of Knowledge and Medscape) has been performed in order to obtain a comprehensive evaluation of available psychopharmacological treatment in HD. Results Antidepressants like selective serotonin and serotonin norepinephrine reuptake inhibitors improve depression and are also used in obsessive-compulsive symptoms in HD patients. Mood stabiliser (Valproic Acid or Lamotrigine), alone or in combination with other drugs, are used in pathological mood swings and irritability. Atypical antipsychotics (Risperdidone, Olanzapine and Aripiprazole) were used in psychotic symptoms, and for managing agitation also in place of Tetrabenazine, with reduction of pathological movement. Conclusions Psychiatric symptoms in HD seem to respond well to psychopharmacological treatment. It is important to recognise psychiatric aspects and tailoring specific treatment, not only for psychopathology treatment with improvement of mood, ideation and quality of life of patients and prevention of serious complications how suicidality, but even for better managing neurological symptoms in HD.

Background The clinical manifestations of Huntington Disease include motor, cognitive and psychiatric disturbances. There is a wide spectrum of symptoms and the presence of disorders in psychiatric field worsens autonomy and quality of life of the patients. Main psychiatric syndromes may appear during progression of Huntington Disease, often in a non-typical way. Some authors have noticed even 20 years before onset of chorea or dementia symptoms of Huntington Disease. Aims We present a review of literature describing the main psychopathological pictures in Huntington Disease, whose prevalence is estimated between 33% and 76%. Results It is possible to make diagnosis of major depression in a percentage between 9% and 63%, and the suicide rate in patients is 4 to 6 times higher than normal population, with greater prevalence among patients over 50 years old. Hypomania and mania have been estimated in 4,8% to 10% of patients. Anxiety has been less studied however some studies report that it also occurs frequently (34–61%). Prevalence of irritability varies between 38% and 73%, whereas obsessive and compulsive symptoms are comprised between 5% and 52%. A picture of psychosis has prevalence estimated at 4% to 12%. Delirium, apathy and neuropsychological impairments are strictly correlated with the progression of the disease. Conclusions It is important to recognise psychiatric facets in HD, in order to tailor the psychopharmacological therapy and reduce the burden for the caregiver.