- Obsessive Compulsive Behavior
Obsessive and/or compulsive symptoms occur frequently in Huntington's and often worsen as the disease progresses [Beglinger LJ 2007]. Obsessions are persistent thoughts which "get stuck", which can be accompanied by compulsions which are the behaviors or actions associated with obsessive thoughts. As an example, the thought of absolute need for cleanliness can be followed by the behavior of obsessive hand washing. Inflexibility, repeating phrases or behaviors are stressing for both patient and care-partner. These symptoms represent a type of anxiety.
Treatments for Obsessive Compulsive Behavior: First line treatments are SSRI antidepressant drugs, several of which have been FDA approved for obsessive compulsive symptoms. These include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), and fluvoxamine (Luvox®). The NSRI antidepressant drug venlafaxine (Effexor®) has been approved for severe anxiety and is also used for obsessive compulsive symptoms. Often higher doses of these drugs are needed than those used for depression. Clomipramine (Anafranil®) that has combined SSRI and tricyclic is not used first due to greater side effects, but can have benefit in HD. Mirtazepine (Remeron®) is an atyptical antidepressant that is FDA approved for obsessive compulsive disorders.
Antipsychotic drugs are used for this condition only when other drugs are not successful, often as an "add on. There is a single case report of successful use of the antipsychotic drug olanzapine (Zyprexa®) for this symptom in Huntington's [Paleacu D 2002]. Risperidone (Risperdal®) or quetiapine (Seroquel®) are other drugs from this class that can be added if other medications fail. Mood stabilizers are only rarely used, and reserved if all other drugs fail.
Treatment Algorithm for Obsessive Compulsive Behavior in Huntington's disease [Anderson K 2011] can be downloaded from this article for your physician, detailing expert preference drug management of this symptom in HD.
Beglinger LJ, Langbehn DR, Duff K, Stierman L, Black DW, Nehl C, Anderson K, Penziner E, Paulsen JS; Huntington Study Group Investigators. Probability of obsessive and compulsive symptoms in Huntington's disease. Biol Psychiatry. 2007 Feb 1;61(3):415-8. Epub 2006 Jul 12. PubMed abstract
Paleacu D, Anca M, Giladi N. Olanzapine in Huntington's disease. Acta Neurol Scand. 2002 Jun;105(6):441-4. PubMed abstract
Anderson K, Craufurd D, Edmondson MC, Goodman N, Groves M, van Duijn E, van Kammen DP, Goodman L. An International Survey-based Algorithm for the Pharmacologic Treatment of Obsessive-Compulsive Behaviors in Huntington's Disease. PLoS Curr. 2011 Sep 20;3:RRN1261. PubMed abstract