Others are incorrigible. In these cases, the family learn more should be encouraged to “pick their

battles.” Confrontations should be saved for situations having to do with safety. This will be an easier point to get across if the family understands that these behaviors are due to the HD itself and that their loved one cannot “be reasonable.” Sometimes perseverative patients are treated with SSRIs for their presumptive “antiobsessive” effect. There is some theoretical basis for a dopamine-augmenting strategy in the treatment of executive dysfunction. A case has been reported of successful treatment with amantadine of an HD patient with an extreme syndrome characterized by perseveration, Inhibitors,research,lifescience,medical disinhibition, and severe aggression,3 as well as a case series showing positive results in psychiatric inpatients with executive dysfunction in the context of various forms of dementia.31 Inhibitors,research,lifescience,medical Nonspecific psychiatric conditions also found in HD Delirium Delirium is common in HD, and may result from volume depletion, poor nutrition, medical complications, metabolic disturbances such as urinary tract infections and pneumonias, and medication effects. Occult subdural hematomata from unwitnessed falls Inhibitors,research,lifescience,medical and head injuries are also a common and dangerous cause of delirium.

The rule of thumb is that nothing changes rapidly in HD. A sudden change in behavior or Inhibitors,research,lifescience,medical decline in cognitive abilities should prompt an evaluation for delirium. The definitive treatment for delirium is to discover and correct the cause, but low-dose neuroleptics are probably the safest pharmacologic treatment for short-term management of an agitated delirium. Demoralization Despite the caveat against assuming a reactive explanation for all depressive symptoms Inhibitors,research,lifescience,medical in HD, patients with HD can and do become demoralized. This occurs particularly at times of loss, such as when a person with HD is forced to stop working, or give up driving. Patients who are also suffering from a dysexecutive syndrome may

find it especially difficult to move on, and hospitalizations and suicide attempts have resulted from such losses. Other times, patients who are doing check well may bring up suicide as an option for the future, “before things get too bad.” The clinician should listen sympathetically to such statements, which reflect the patient’s fear of impending helplessness, but should not overreact. Few HD patients actually kill themselves in such a premeditated way, perhaps because they tend to become increasingly unaware of their deficits as cognitive and executive function declines.32 Sexual problems The most common sexual disorders in HD, hypoactive sexual desire and inhibited orgasm, have been reported in 63% and 56% of men, and 75% and 42% of women.