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Abstract

BackgroundHuntington's disease (HD) is a dominantly inherited, neurodegenerative disorder due to expansion of a polymorphic trinucleotide repeat in the short arm of chromosome 4. Clinical manifestations consist of a triad of choreic movements, cognitive decline and psychiatric syndromes starting in the fourth to fifth decade. Psychiatric manifestations vary and may precede motor and cognitive changes. Personality changes and depression occur most commonly. Paranoid schizophrenia-like symptoms occur in 6% to 25% of cases.Case reportWe describe a 55 year-old woman with an 8 yearlong history of behavioural changes, multi-thematic delusions and auditory hallucinations. History and mental state examination were suggestive of paranoid schizophrenia. Neurological examination revealed discrete, involuntary movements affecting her arms and trunk. Genotyping detected an expanded allele (43 trinucleotide repeats). A three-generation-long family history of chorea and schizophrenia-like psychosis was found.ConclusionHD-families have been reported in which schizophrenia-like syndromes emerged in all or most HD-affected members long before they developed extra-pyramidal or cognitive changes. This has been attributed to more than mere coincidence. We hypothesise that in these families the HD gene is transmitted along with a low load of small-effect "psychosis genes" which, in the presence of the severe cognitive changes of HD, manifest as a schizophrenia-like phenotype. Further research is needed in order to clarify the links between genetic loading and the emergence of psychotic symptoms in Huntington's disease.

Association of Pre-Onset Cannabis, Alcohol, and Tobacco Use With Age at Onset of Prodrome and Age at Onset of Psychosis in First-Episode Patients

“…Male cannabis users had their first psychotic episode on average 6.9 years earlier than male nonusers, and cannabis use was a stronger predictor of age at first psychotic episode than gender. Fifth, 79 retrospectively studied first-episode patients abusing cannabis had an earlier onset compared with 186 not using cannabis, though this study evidently did not control for the influence of gender, and only 18% of females used substances compared to 44% of males (19). Sixth, among 152 first-episode patients, those reporting past substance use were significantly younger at onset of psychotic symptoms than those who had not used substances (9).…”

“…Rates of alcohol misuse range 27–43% in first-episode samples (9,11–15), and 50–75% of first-episode patients smoke cigarettes daily (11,13,16). Many first-episode studies demonstrate that substance use initiation typically precedes psychosis onset, often by several years (4,17–19). This is true of cannabis use in particular (1,20).…”

Health Services for Management of Chronic Non-Cancer Pain in Kuwait: A Case Study Review

“…Several studies have reported that chronic pain is associated with an increased prevalence of anxiety or depressive disorders, especially amongst those who experience significant limitations in their daily activities due to pain (e.g. work, social activities, family life) [ 72 , 73 , 74 , 75 ]. Sleep disturbance, fatigue, and decreased overall functioning are also commonly experienced [ 76 ].…”

“…Certain basic interventions should be incorporated into all treatment plans, for all kind of populations. For example, significant reduction in health complications due to chronic pain usually can be achieved through therapeutic interventions such as multimodal analgesia and controlled prescription of analgesic drugs [ 64 , 75 ]. In addition, individually assessed needs, risk factors, and ability to afford recommended care must be considered.…”

Integrative Therapies and Pediatric Inflammatory Bowel Disease: The Current Evidence

“…UC patients demonstrated higher therapeutic success than CD patients [ 81 ]. A systematic review of 12 studies investigating antidepressants in IBD concluded that although most studies showed some benefit, there is currently insufficient data to determine the efficacy of antidepressants in IBD [ 82 ]. For practitioners, considering the overlap between IBS and IBD may help guide integrative treatment of IBD patients.…”