Introduction Neuropsychiatric features are characteristic symptoms in Huntington’s disease (HD). Compelling evidence proved high prevalence of alterations on mood and affect. However, little is known about psychotic symptoms in HD.

Objective Describe the characteristics and phenomenology of psychotic symptoms in a Spanish cohort of Huntington’s disease patients.

Methods From the Spanish Registry cohort, genetically positive patients with psychiatric, cognitive and motor assessment were included. We analysed demographic, genetic and clinical data. Cognitive and motor functions were measured with Unified Huntington Disease Rating Scale (UHDRS), psychiatric disturbances with the Problem Behaviour Assessment Scale (PBA-s) and function with the total functional capacity (TFC).

Results 264 patients were included (46.2% males; mean age of 45.2 ± 12.5y; disease duration 5.5 ± 5.5y and mean CAG 44.1 ± 4.7). Delusions were present in the 10.2% of the patients and hallucinations in 4.5%. Visual hallucinations were the more frequent 3.4% followed by auditory 1.9%. UHDRS cognitive score (p = 0.05) and TFC (p = 0.01) were more impaired in patients with psychotic symptoms. No other differences or correlations between delusions/hallucinations and cognitive, motor or functional scores were found. Formal diagnosis of schizoaffective disorder was present in two patients, previous acute psychotic episode in one, dementia in one and young HD in one.

Conclusions Psychotic symptoms are infrequent in HD. Delusions are more frequent than hallucinations being the visual ones the more recurrent. Despite not found correlation, patients presenting psychosis/hallucinations are significantly more impaired on cognition and functional capacity.