Objectives

Huntington’s disease (HD) is a rare neurodegenerative disorder that may present with psychotic symptoms in 3–10% of cases, often preceding motor manifestations. Treating Huntington’s disease poses challenges due to the need for careful selection of medications.

Case report

This case report describes a 45-year-old male with HD who exhibited persecutory delusions and delusions of influence, requiring psychiatric intervention. Initial treatment with olanzapine (25 mg) was only partially effective, prompting a switch to clozapine (450 mg), which led to full remission of psychotic symptoms.

Conclusions

This case highlights the diagnostic challenges in distinguishing psychosis in HD from primary psychiatric disorders, and underscores the need for individualised treatment approaches, particularly in nicotine-dependent patients. Current evidence suggests that olanzapine, clozapine, risperidone, and fluphenazine are among the most effective options, although dosage adjustments may be necessary. A multidisciplinary approach and specialised care centres are essential for the optimal management of HD-related neuropsychiatric symptoms.