The White man's burden - a case study caught between bipolar affective disorder and Huntington's disease

• Published in: Fortschritte der Neurologie-Psychiatrie Vol. 81; no. 6; p. 337
• Main Authors: Nowidi, K, Kunisch, R, Bouna-Pyrrou, P, Meißner, D, Hennig-Fast, K, Weindl, A, Förster, S, Neuhann, T M, Falkai, P, Berger, M, Musil, R
• Format: Journal Article
• Language: German
• Published: Germany 01.06.2013
• Subjects: Antidepressive Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Bipolar Disorder - complications; Bipolar Disorder - diagnosis; Bipolar Disorder - psychology; Citalopram - therapeutic use; Dibenzothiazepines - therapeutic use; Female; Genetic Testing; Heterozygote; Humans; Huntington Disease - complications; Huntington Disease - diagnosis; Huntington Disease - psychology; Magnetic Resonance Imaging; Middle Aged; Movement Disorders - etiology; Movement Disorders - therapy; Neurologic Examination; Neuropsychological Tests; Pedigree; Positron-Emission Tomography; Quetiapine Fumarate; Tiapride Hydrochloride - therapeutic use
• ISSN: 1439-3522
• DOI: 10.1055/s-0033-1335040

We report upon a case of a 55 year old patient with a bipolar affective disorder, presenting herself with a depressive symptomatology in addition to a severe motor perturbation. The main emphasis upon admittance was perfecting and improving her latest medication. Four weeks prior to her stay at our clinic a thorough neurological examination had taken place in terms of an invalidity pension trial which did not result in any diagnostic findings. Therefore a neurological disease seemed at first highly unlikely. Even though the prior testing was negative, the ensuing neurological examination at our clinic resulted in movement disorders very much indicative of Huntington's Disease. A detailed investigation in regards to the particular family history of the patient was positive for Huntington's Disease. However, whether the patient's mother had also been a genetic carrier of Huntington's Disease was still unknown at the time the patient was admitted to our clinic. It was nevertheless discovered that her mother had also suffered from a bipolar affective disorder. A genetic testing that followed the neurological examination of the patient proved positive for Huntington's Disease. Neuro-imaging resulted in a bicaudate-index of 2.4 (the critical value is 1.8). In a clinical psychological test battery the ensuing results were highly uncommon for patients with solely a bipolar affective disorder people. Under the medical regimen of Quetiapine, Citalopram and Tiaprid the patient's mood could be stabilized and there was some improvement of her motor pertubation.