White Man’s Burden – Im Grenzgebiet zwischen bipolarer affektiver Störung und Huntington-Erkrankung

Zusammenfassung

Wir berichten über den Fall einer 55-jährigen Patientin mit einer vorbestehenden bipolaren affektiven Störung, die mit einer depressiven Symptomatik sowie mit einer starken motorischen Unruhe zur medikamentösen Optimierung in unserer psychiatrischen Klinik vorstellig wurde. Im klinischen Untersuchungsbefund imponierte ein choreatisch-athetotisches Bewegungsmuster, obgleich erst vier Wochen vor Aufnahme eine ausführliche neurologische Untersuchung im Rahmen eines Rentenantrags keinen pathologischen Befund ergeben hatte. In einer eingehenden neurologischen Untersuchung bestätigte sich die Verdachtsdiagnose einer Huntington-Erkrankung. Eine weiterführende anamnestische Exploration der Patientin ergab eine positive Familienanamnese sowohl für bipolare affektive Störungen als auch für die Huntington-Erkrankung. Unklar war bis zum Zeitpunkt der stationär-psychiatrischen Aufnahme, ob die Mutter der Patientin, bei der ebenfalls eine bipolare affektive Störung diagnostiziert worden war, auch Merkmalsträgerin der Huntington-Erkrankung gewesen war. Die Verdachtsdiagnose konnte durch eine genetische Testung bestätigt werden. In den bildgebenden Verfahren zeigte sich ein Bikaudatum-Index von 2,4 (pathologischer Grenzwert: 1,8) und in der Testpsychologie ein für bipolare affektive Störungen untypisches Muster. Unter der Therapie mit Quetiapin, Citalopram und Tiapridex konnte sowohl eine affektive Stabilisierung erreicht werden als auch eine gewisse Besserung der motorischen Bewegungsstörung.

Abstract

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.

Schlüsselwörter

bipolare affektive Störung - Chorea - Huntington-Erkrankung - Morbus Huntington - HD

Key words

bipolar affective disorder - chorea - Huntington disease - Huntington’s disease - HD

^* Die Autoren haben zu gleichen Teilen zu der Arbeit beigetragen.

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