Huntington disease psychiatry — structured clinical viva

Leading diagnoses: HD-related major depression with passive SI plus irritability/aggression, possible apathy overlap, on background of manifest HD; consider tetrabenazine-related dysphoria after recent titration.^[1][2][5]

Differentials to voice: delirium/infection; pure apathy; primary mood disorder coincidental; substance use; emerging psychosis.^[3][7]

Acute plan: structured suicide assessment and safety planning; collateral for aggression; joint neurology review of VMAT2 dose; start SSRI for depression/irritability if indicated (e.g. sertraline low start); escalate to low-dose SGA if severe aggression/psychosis; non-drug structure and carer support.^[2][3][4]

Chorea drugs: TETRA-HD/FIRST-HD literacy — benefit for chorea, monitor depression/parkinsonism.^[5][6]

Ethics: do not casually predictively test asymptomatic minors for adult-onset HD; support adult relatives through counselling pathways.^[7]

Close: multidisciplinary HD clinic, advance care planning while capacity intact, ongoing suicide surveillance.^[3][7]