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There is a need to confirm the diagnosis through genetic test because of the disorders that mimic HD. Genetic nature of the disease does not preclude a neurologist from treating the symptoms and improving the quality of life. Absence of family history does not rule out the diagnosis of HD. It is very much important to encourage multidisciplinary care for these patients starting with a psychiatry referral. Drugs that decrease chorea (neuroleptics/tetrabenazine) can cause parkinsonism or extrapyramidal symptoms. So it is a fine balancing of the doses to prevent either extremes. It may vary dependent on each patients pharmacokinetics and receptor dynamics. So regular follow up is recommended
Genetic nature of the disease should not discourage a psychiatrist to treat the behavioural symptoms of HD patients. Many patients respond well to the psychiatric symptoms similar to primary psychiatric disorders. The role of therapies like CBT (cognitive behavioural therapy) etc has been neglected so far in the field of HD and should be considered. Psychiatric manifestations play a major role in the dysfunctionality of the patients more than what is traditionally believed.
Psycho social education is of prime importance to empower the families with HD. In India because of the negative impact of socio-economic and cultural conditions, psycho social distress is huge. HD patients need continuous support of PSW professionals.
Today in India we lack adequate Genetic counsellors and almost none specialized in HD which needs specific components to be focussed. Rampant genetic testing without counselling is an impending hazard for the Indian community currently.