Obsessive and compulsive symptoms in prediagnosed Huntington's disease.
OBJECTIVE
Obsessive and compulsive symptoms (OCS) are more prevalent in patients with diagnosed Huntington's disease (HD) than in the general population. Although psychiatric symptoms have been reported in individuals with the HD gene expansion prior to clinical diagnosis (pre-HD), little is known about OCS in this phase of disease.


METHODS
The goal of this study was to assess OCS in 300 pre-HD individuals and 108 non-gene-expanded controls from the Neurobiological Predictors of Huntington's Disease (PREDICT-HD) study (enrolled between November 2002 and April 2007) using a multidimensional, self-report measure of OCS, the Schedule of Compulsions, Obsessions, and Pathologic Impulses (SCOPI). Additionally, pre-HD individuals were classified into 3 prognostic groups on the basis of age and CAG repeat length as "near-to-onset" (< 9 estimated years to onset), "mid-to-onset" (9-15 years to onset), and "far-to-onset" (> 15 years to onset). We compared the 3 pre-HD groups to the controls on SCOPI total score and 5 subscales (checking, cleanliness, compulsive rituals, hoarding, and pathologic impulses), controlling for age and gender.


RESULTS
All models showed a significant (p < .05) group effect except for hoarding, with an inverted-U pattern of increasing symptoms: controls < far-to-onset < mid-to-onset, with the near-to-onset group being similar to controls. Although the mid-to-onset group showed the most pathology, mean scores were below those of patients with diagnosed obsessive-compulsive disorder. SCOPI items that separated pre-HD individuals from controls were focused on perceived cognitive errors and obsessive worrying.


CONCLUSIONS
Subclinical OCS were present in pre-HD participants compared to controls. The OCS phenotype in pre-HD may present with obsessive worrying and checking related to cognitive errors and may be a useful target for clinical screening as it could contribute to functional status.
Beglinger
Leigh J
LJ
University of Iowa, Department of Psychiatry, MEB 1-321, Iowa City, IA 52242-1000, USA. leigh-beglinger@uiowa.edu
Paulsen
Jane S
JS
Watson
David B
DB
Wang
Chiachi
C
Duff
Kevin
K
Langbehn
Douglas R
DR
Moser
David J
DJ
Paulson
Henry L
HL
Aylward
Elizabeth H
EH
Carlozzi
Noelle E
NE
Queller
Sarah
S
Stout
Julie C
JC
D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D003192:Compulsive Behavior / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006816:Huntington Disease / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D009770:Obsessive Behavior / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D012306:Risk