Huntington disease psychiatry

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Target exams

Red flags

• Suicide risk is elevated across premanifest and early–mid HD — assess at every contact, especially after genetic disclosure
• New or worsening depression after starting a VMAT2 inhibitor (tetrabenazine, deutetrabenazine, valbenazine) — treat as drug-related dysphoria until proven otherwise
• Covert predictive testing or casual testing of asymptomatic minors for adult-onset HD is unethical outside specialist frameworks
• Severe irritability/aggression toward carers is a core HD neuropsychiatric target — not 'personality' alone
• Apathy without dysphoria is not the same as major depression — different management emphasis
• Acute behavioural change with fever, aspiration risk, or metabolic upset — delirium until proven otherwise
• High-dose typical antipsychotics can cause severe rigidity, falls, and medical complications without stepwise review