Premorbid combat related ptsd in Huntington's disease - Case report

Huntington's disease (HD) is a neurodegenerative, autosomal dominant disease that manifests with a triad of symptom clusters including movement disorder, cognitive impairment and psychiatric symptoms. We present a patient with HD who, prior to developing neurological signs and symptoms, had been exposed to war trauma and had developed posttraumatic stress disorder. Fifteen years later he manifested with dysarthria, difficulties with swallowing and involuntary movement. What brought him to psychiatrist was a heteroanamnestically noticed change in personality with irritable mood, impulsivity, aggressive outbursts in behavior and delusional ideation. Therapy was stared with haloperidol, but patient developed severe extrapiramidal side effects. Subsequent treatment with olanzapine, diazepam and omega 3 fatty acids lead to mood stabilization and better impulse control with even some improvement in motoric symptoms. To our knowledge, this is the first case report on combat related PTSD as psychiatric disorder manifested prior to HD. We discuss a possible influence of psychological stress disorder on severity of psychiatric symptoms in the HD. The importance of personalized approach in both psychopharmacological and psychotherapeutical treatment of patients with HD is emphasized. If the influence of environmental stress on the psychiatric phenotype of the disease should be confirmed by clinical trials and further studies, both screening methods and interventions aimed to reduce psychological stress in carriers of Huntington gene could be considered.