ECT in the Treatment of Organic Psychosis in Huntington's Disease

Huntington's disease (HD) is a progressive neurological disorder characterized by choreiform movements, dementia, and psychiatric symptoms. The psychiatric symptoms often lead to long-term psychiatric hospitalization. We report the case of a 49-year-old woman with HD of 1 year's duration who presented with an organic psychotic syndrome with voices telling her to kill herself or her children. The psychosis was refractory to neuroleptic treatment (up to 1,250 mg chlorpromazine equivalents per day). Depressive symptoms emerged but were neither of a magnitude nor of a duration to suggest a major affective disorder. Nonetheless, we treated the patient empirically with antidepressants, which had to be discontinued because of symptomatic orthostatic hypotension. Based on the persistent psychosis with suicidal and homicidal ideation and possible long-term state psychiatric hospitalization, we recommended electroconvulsive therapy (ECT). ECT was successful in treating the psychosis as well as the depressive symptoms. There was no worsening of the patient's dementia and only a slight progression in her choreiform movements. The authors question whether ECT may be of benefit in treating the psychosis of HD in the presence or absence of depressive symptoms and call for further research to determine if the use of ECT in HD patients with psychosis could prevent, or at least delay, placement in a long-term psychiatric hospital.