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7 Sep 16

Coping with Behavioural Disturbances
in Huntington’s Disease

by Pete Ellis
Department of Psychological Medicine
Wellington School of Medicine

A presentation delivered to the Wellington Conference 1997
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Personality Problems

Personality problems are the most common and least studied issue. Now I should say what I mean by personality. Usually, we mean those aspects of a persons usual style of relating to others and to themselves that are enduring and characteristic of the particular individual. We also tend to regard people as responsible for any actions based on their own character. However, as a result of brain injury of any type people may suffer a change in their character. We refer to this as organic personality change. This can be very difficult to change and the fact that it is due to a disease process or the result of injury is very important, I think - such changes are not within people’s ability to reverse, although their efforts may limit the effects. Perhaps I can make an analogy with a broken leg. If I break my leg, and have to keep it off the ground for a period, there is no way I can walk unaided. In the summer, I walk to work over Mount Victoria. Now, I could say that I could no longer go to work, or I could ask my wife to drive me there, use crutches around the hospital and so on. Like the person with an organic personality change, I cannot reverse the original problem; provided with some support and understanding, I may be able to partially compensate for some activities, but not others. For example, helping with the school camp would be impossible.

Apathy may be part of depression; a result of excessive sedating medication; an unstimulating environment; or the result of decreased functioning of the frontal lobe of the brain due to disease processes. Before saying that it is the latter, and accepting the need that it cannot be reversed, we need to be sure that it is not due to another reason which is easier to completely reverse. Intermittent explosive disorder is a condition where an individual is able to maintain a reasonable level of functioning most of the time but is prone to a major catastrophic outburst over an apparently trivial matter, for reasons which are not always clear, although often a careful consideration of what has been happening recently will reveal an accumulation of stresses.

I think it is also important that professionals acknowledge that irritability is more commonly expressed at home, away from clinics and relative strangers. I think we all tend to feel freer to express our feelings of irritation more openly with those who know us best.

Personality Changes

There are some suggestions from PET scans that personality changes in HD are associated with changes in the limbic system of the brain, which is the part of the brain which controls our emotions.

Aggression

Aggression is a problem that concerns many people. The first priority in the face of aggression is to ensure the safety of all involved. This is more easily said that done, but in the face of physical aggression it is important that carers are aware that in emergencies the police can assist, as can the various psychiatric emergency teams around the country. I am mentioning this first to make it clear that this is sometime necessary, but I hope that other measures at an earlier stage of things would reduce the need for this.

It is vital to consider what may be causing the aggression. It may reflect May reflect personality change, or sometimes previous personality. It may be due to persecutory delusions, where a person believes that they are being persecuted and have to fight back to protect themselves, or to the irritability that may be part of a depressive illness. It is said to be more common early in the disease than in the middle or late stages.

Management consist of treating the underlying cause and of course ensuring safety. Antipsychotics are indicated for delusions, antidepressants for depression, and perhaps propanolol for frustration and impatience

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Appreciation and thanks must go to Judy Lyon for compiling the wealth of information available
on this site, and to Graham Taylor for maintaining the original site for so long.

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