|Although uncommon in HD, is a highly treatable condition.
It is characterized by the acute onset of overwhelming anxiety and dread, accompanied by physiological symptoms of
rapid heartbeat, sweating, hyperventilation, lightheadedness, or paraesthesias.
Panic attacks usually last only fifteen or twenty minutes, may begin during sleep,
and may result in syncope. Suspected panic attacks require a good medical work-up, because most of the other possible explanations
for the symptoms represent highly dangerous conditions.
Once these other causes have been ruled out, the usual treatment consists of SSRIs,
sometimes temporarily supplemented with benzodiazepines.
SSRIs are usually mildly stimulating and may need to start at a lower dose than that
used for depression.
Benzodiazepines should be used judiciously in anxious persons
with HD because of the vulnerability of these patients to delirium and falls and because of their potential for abuse,
especially in patients whose judgement may already be impaired.
PRN medications may have to be controlled by a family member. Some patients will
respond to the non-benzodiazepine anxiolytic buspirone, which can be started at 5mg two to three times per
day and advanced to 20-30mg per day in divided doses.