Table 5.

Clinical Practice Guidelines for Psychosis in HD

General Treatment Recommendations

Identify and treat comorbid medical conditions that can precipitate acute onset of psychotic symptoms that include infectious, metabolic, toxic, drug-related, substance use, or other medical or acute psychosis/delirium.

Treat co-existing psychiatric symptoms of HD including obsessive perseverative and sleep disorders.

Modify external environmental factors that may contribute to distress of psychotic symptoms.

Pharmacologic Recommendations

An antipsychotic drug is the first line pharmacologic treatment for psychosis in HD.

An alternative antipsychotic should be used when psychotic symptoms have not been adequately controlled by the initial drug.

Exceeding maximum recommended dose of any antipsychotic is discouraged.

Combining antipsychotic drugs is discouraged, reserved only for more severe presentations of psychosis in HD.

Consider clozapine when psychotic symptoms have not adequately responded to other antipsychotics in those situations where interval blood testing is possible.

Regularly reassess the continued need of an antipsychotic because many of the adverse effects of these drugs are difficult to distinguish from aspects of disease progression.