engleski

Huntington's disease or schizophrenia - does it really matter? /in forensic evaluations/

Background and aims. – Huntington’s disease (HD) is a neurodegenerative disease characterized by motor, psychiatric and cognitive symptoms. Although the main criteria for HD diagnosis include positive genetic test and involuntary choreiform movements, “premotor” symptoms like depression, psychosis, impulsivity, hostility or cognitive impairment can present years or even decades before the motor abnormalities. Our aim was to discuss potential differential diagnosis in the case of a forensic patient previously diagnosed with schizophrenia who developed HD with progressive cognitive decline later-on. Methods.–Wepresentrelevantclinicaldataincludinghistory, psychiatric evaluation and complete diagnostic work-up. Results.– A 50-year-old male patient diagnosed and treated for paranoid schizophrenia since 2012 was admitted to the Forensics department after he was assessed not guilty for the reason of insanity for murder attempt of a passer-by in 2017 due to acute psychosis. During 8 months of hospital treatment his state has worsen rapidly with disorganized behavior, visual hallucinations, cognitive deterioration, weight loss, inability to control sphincters or to take care of himself. Due to these specific symptoms and positive psychiatric heredity for both schizophrenia and dementia, a wide range of diagnostic work-up was done revealing CAG triplets and positive genotype with CAG-expanded allele gene characteristic for HD. Conclusions.– Although the patient fulfilled diagnostic criteria for schizophrenia confirmed by multiple psychiatrists and forensic evaluation, later course of illness questions the nature of his psychotic decompensations: were they relapses of schizophrenia or early, non-specific representations of HD? But, whatever the case, the forensic evaluation of his criminal responsibility would be the same. Disclosure of interest.– The authors have not supplied a conflict of interest statement.

forensic evaluation ; forensic psychiatry ; Huntington's disease ; schizophrenia

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