After 2 years of social breakdown, he left home and became a homeless runaway. Because of inhibited speech, it was hard to dismiss hallucinations of any kind, but he admitted to being followed by a group of people in a persecutory delusional fashion.Īccording to family members, his behavior had started to deteriorate 9 years ago at age 26, with obsessive hyperreligiosity, perseverating speech, and compulsive hoarding, resulting in syllogomania. He had facial motor stereotypies, psychomotor retardation, diffuse muscular rigidity, and choreiform movements of limbs, and his gait was ataxic with wide-based station.
He was in complete apathy with depressive mood and blunted affect.
He had been found in the street sleeping near a metropolitan train station, with very poor hygiene and pungent stench and covered in his own urine and fecal matter. Case ReportĪ 35-year-old Black man living homeless in an urban area for the last 7 years was admitted to the psychiatry emergency department for social withdrawal and extreme self-neglect. Here, a case report is presented of a young homeless man with Diogenes syndrome, secondary to dementia due to the Westphal variant of Huntington’s disease, who was previously diagnosed with depression with psychotic symptoms. 4 The Westphal variant of Huntington’s disease is a distinct clinical entity characterized by childhood onset and a rigid-hypokinetic syndrome. 3 The juvenile variant of Huntington’s disease, with onset before age 20 years, accounts for up to 10% of all cases, but only 2% have symptoms before age 10 years, which is known as the Westphal variant.
Huntington’s disease is an autosomal dominant progressive disease caused by a cytosine-adenine-guanine (CAG) repeat expansion in the huntingtin (HTT) gene, characterized by the triad of choreic abnormal movements, cognitive decline, and psychiatric disturbances. 1 In a systematic review of the literature regarding Diogenes syndrome, 19% of cases were associated with dementia, and 16% of the patients were aged < 65 years. Diogenes syndrome is a behavioral disorder usually described in individuals in a neglected physical state living in extreme squalor, unhygienic conditions, and self-imposed isolation, who often refuse external help and have a tendency to accumulate unusual objects.
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