Problem:
This 37-year-old man presents to the psychiatry emergency room for inappropriate behavior and confusion. He works as a janitor and has had reasonably good work attendance. His coworkers say that he has appeared "fidgety" for several years. They specifically mention jerky movements that seem to affect his entire body more recently. His mother is alive and well, although his father died at age 28 in an auto accident. On examination, he is alert but easily distracted. His speech is fluent without paraphasias but is noted to be tangential. He has trouble with spelling the word "world" backwards and serial seven's, but recalls three objects at 3 minutes. His constructions are good. When he walks, there is a lot of distal hand movement, and his balance is precarious, although he can stand with both feet together. His reflexes are increased bilaterally, and there is bilateral ankle clonus. A urine drug screen is negative. Most likely diagnosis: Huntington disease. Next diagnostic step: Genetic counseling and genetic testing for Huntington disease. Review the history very carefully with patient and his relatives and assess medications-either illicit or licit that could be responsible. Molecular or genetic basis: Repeat CAG triplets present in a gene called. Need Assignment Help?