Perseverative Behaviors Warrant Attention in Patients With Huntington Disease

Separate reporting of obsessive-compulsive behaviors and perseverative behaviors in patients with Huntington disease is uncommon and may allow clinically important behaviors to go unnoticed, according to a review article published in Behavioural Brain Research.

Per the DSM-5 Text Revision, obsessive-compulsive disorder (OCD) is characterized by time-consuming obsessions, compulsions, or both, which cause significant distress. Perseverative behaviors, the authors explained, are transdiagnostic and characterized by uncontrolled repetition or continuous responses that can manifest in motor, verbal, or cognitive forms. 

>>NEWS: Severe Mental Illness Upped Risk of Death After Positive COVID-19 Test

“Huntington disease gene expansion carriers (HDGECs) may present with perseverative behaviors as the main symptom, without fulfilling the OCD criteria,” wrote corresponding author Natalia Pessoa Rocha, PhD, PharmD, of the University of Texas Health Science Center, Houston, Texas, and coauthors. “HDGECs often exhibit a lack of insight into their symptoms, a condition known as anosognosia. They may not necessarily be distressed by these symptoms, and their perseverative thoughts can be attributed to cognitive impairment resulting from the neurodegenerative processes.”

Despite the differences between obsessive-compulsive and perseverative behaviors, most of the evidence fails to make a distinction between them. For example, few assessment tools present perseverative thoughts or behaviors as a separate item.

“Even when the item exists, it is commonly reported as a composite score in combination with the obsessive-compulsive item,” the authors wrote.

Perseverative behaviors are not benign, however, and can pose a significant psychological burden in patients with Huntington disease. They are associated with cardiovascular symptoms, suicide, and other somatic symptoms and high-risk behaviors, according to the article.

“Recognition and monitoring of perseverative behaviors in Huntington disease can aid in early detection of concerning symptoms and differentiating overlapping illnesses,” the authors advised.

Reference

Zadegan SA, Kupcha L, Patino J, Rocha NP, Teixeira AL, Furr Stimming E. Obsessive-compulsive and perseverative behaviors in Huntington’s disease. Behav Brain Res. 2024;458:114767. doi:10.1016/j.bbr.2023.114767