Obsessions are recurrent, intrusive thoughts or impulses which are experienced
as being senseless, at least initially.
A compulsion is a repetitive performance of the same activity, a stereotyped
routine which must be followed, often in response to an obsession, such as handwashing because of an obsessive concern with
Obsessions are usually a source of anxiety and the patient may struggle
to put them aside, whereas the acting out of compulsions generally relieves anxiety and may not be as strongly resisted.
True Obsessive-Compulsive Disorder (OCD) is rare in HD, but HD patients often display
an obsessive preoccupation with particular ideas. Patients may worry about germs or contamination, or engage in excessive
checking of switches or locks.
Sometimes patients will become fixated on an episode of being wronged in the past (e.g.
fired from a job, divorced, driver's license revoked), and then bring it up constantly, or become preoccupied with some perceived
need, such as a desire to go shopping, or to eat a certain food.
Serotonergic antidepressants are used to treat OCD and may ameliorate obsessions and compulsions
in HD patients that do not meet the criteria for the full syndrome.
The use of the tricyclic antidepressant clomipramine (Anafranil) has largely been superceded
by the SSRIs fluoxetine, sertraline, paroxetine and fluvoxamine (Luvox) which have milder side effects and lower lethality
in overdose. Patients may require higher doses than those needed for depression,
e.g. 40-60mg of fluoxetine.
For relentless perseverative behavior unresponsive to these agents, one might consider
neuroleptics, keeping in mind that the newer, atypical drugs may be better tolerated.