Treatment of Huntington's Disease with Hallucinations and Delusions

Clinical Scenario

In some patients with Huntington's disease, the clinical picture is complicated by neuropsychiatric symptoms — specifically hallucinations and delusions. These are distinct, clinically significant presentations that require a structured pharmacological approach separate from the motor management of HD.

Defining the Presentation

Hallucinations are perceptions without an external object — the patient adheres to and reacts as though the perception genuinely originates from outside themselves.

Delusions are false beliefs arising from incorrect inferences about external reality, inconsistent with the patient's cultural and social context.

Approach Overview

The structured protocol addresses this presentation in a stepwise manner. An initial step involves reviewing the patient's existing medication. First-line pharmacological management draws on a specific class of antipsychotic agents; the appropriate choice within that class depends on the patient's overall motor phenotype and clinical picture. Further decision points and sequencing are defined in the complete protocol.