Background In Huntington’s disease (HD) previous research using the SCL-90-R self-rating questionnaire showed compulsive symptoms, as in obsessive-compulsive disorders (OCD), in 10% to 52% of patients. In opposite to the SCL-90-R (10 items) another self-rating questionnaire, called “Hamburger-Zwangsinventar”, HZI (188 items), asks more detailed for symptoms of compulsiveness. Moreover the HZI divides the symptoms in six differnt catagories of OCD like washing, cleaning or controlling. Thus the HZI might be a more specific tool for the detection of compulsive symptoms. The HZI is not used in HD research so far.
Aims Comparison of compulsive symptoms measured by the HZI and the SCL-90-R in HD and preHD.
Methods/techniques 29 premanifest mutation-carriers (pre-HD) and 40 manifest HD-patients performed both questionnaires in randomised order. Clinical characteristics were rated by using the UHDRS. In addition the criteria OCD defined by DSM-IV or ICD-10 were examined.
Results/outcome Both instruments (SCL-90-R p < 0.0001, HZI p = 0.001) detected more OCD symptoms in HD-patients compared to pre-HD. The SCL-90-R more often detects compulsivity than the HZI in both groups (pre-HD 17.2% versus 3.5%, and HD-patients 60.0% versus 22.5%, Pearson Chi-square test, p = 0,016). Both questionnaires showed a correlation to cognition, depression and disease duration. Compared to OCD-patients, there was a subordinate role in the standardised HZI-subscale for washing and cleaning in HD. Only two female HD-patients fulfilled DSM-IV or ICD-10 diagnosis criteria for OCD.
Conclusions According to our study, using the HZI the frequency of OCD in HD, as defined in DSM-IV or ICD-10, and the intensity of isolated symptoms of compulsivity in pre-HD, is not higher than expected, compared to published numbers of prevalence from total population. However, intensity is higher in manifest HD-patients. The earlier used SCL-90-R might overestimate compulsive symptoms in HD. This is possibly due to misinterpretation of other HD symptoms, caused by dementia or perserverative behaviour as OCD symptoms. The HZI-subscale for washing and cleaning compulsions in manifest HD-patients was the lowest compared to other categories and less relevant compared to OCD-patients, which might be caused by the known loss of disgust in HD-patients.
- compulsive symtoms