H33 A novel biopsychosocial formulation model to conceptualise psychological distress among people with Huntington’s disease

Background Psychological distress is common among people with Huntington’s disease (HD), including gene expansion carriers who have not yet received a clinical diagnosis. In later stages, people with HD (pwHD) can sometimes express their psychological distress with aggressive, risky, or disinhibited behaviours which others might find challenging. Clinical formulation is an approach used by mental health professionals to help understand the various factors that contribute to psychological distress. While formulations have been previously applied to other neurodegenerative diseases, a specific framework has not yet been developed for HD.

Aims The aim was to develop a new clinical formulation model for understanding distress among pwHD based on a biopsychosocial framework. The theoretical rationale for the model, and potential practical applications to HD care, will be discussed.

Methods/Technique The formulation model was conceptualised by UK-based clinical psychologists specialising in HD. It uses a temporal approach and draws upon several biological, psychological, and social/environmental factors that can contribute to distress. These include key elements regarding life story, HD experience and narratives, current presentations (e.g., triad of symptoms, social circumstances), as well as anticipatory cognitions and emotions about the future.

Results/Outcome Following its development, the model has been successfully implemented at a specialist UK HD service, both in multi-disciplinary team meetings and in clinical sessions with pwHD and/or caregivers.

Conclusions This clinical formulation model offers an individualised, evidence-based framework to help enhance the psychological understanding of distress in HD. Its successful implementation shows the potential to improve person-centred care approaches for affected individuals worldwide.