Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Oct;71(4):499–504. doi: 10.1136/jnnp.71.4.499

Social phobia in spasmodic torticollis

H Gundel 1, A Wolf 1, V Xidara 1, R Busch 1, A Ceballos-Baumann 1
PMCID: PMC1763525  PMID: 11561034

Abstract

OBJECTIVES—To study the prevalence of psychiatric comorbidity assessed by the use of a structured clinical interview in a large, representative sample of patients with spasmodic torticollis (ST) and to test the hypothesis that social phobia would be highly prevalent.
METHODS—In a consecutive cohort of 116 patients with ST treated with botulinum toxin overall psychiatric comorbidity was studied prospectively with the structured clinical interview (SCID) for DSM-IV axis I disorders. Physical disability and psychosocial variables were also assessed with standardised self rating questionnaires.
RESULTS—41.3% of the subjects met DSM-IV clinical criteria A-G for current social phobia as the primary psychiatric diagnosis. This figure rose to 56% including secondary and tertiary psychiatric diagnosis. There was no correlation between severity of disease (Tsui score, severity of pain, body image dissatisfaction score) and psychiatric comorbidity. The only significant predictor of psychiatric comorbidity was depressive coping behaviour (logistic regression analysis, p<0.01; OR=10.8). Compared with a representative sample of the general adult population, in the patients with ST the prevalence of clinically relevant social phobia is 10-fold, of mood disorders 2.4-fold, and of lifetime psychiatric comorbidity 2.6-fold increased.
CONCLUSIONS—A particularly high prevalence of social phobia was found in the cohort of patients with ST. The finding of a high prevalence of social phobia and depressive coping behaviour as the main predictor of psychiatric comorbidity may make a subgroup of patients with ST particularly amenable to specific psychotherapeutic interventions.



Full Text

The Full Text of this article is available as a PDF (141.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allison T. G., Williams D. E., Miller T. D., Patten C. A., Bailey K. R., Squires R. W., Gau G. T. Medical and economic costs of psychologic distress in patients with coronary artery disease. Mayo Clin Proc. 1995 Aug;70(8):734–742. doi: 10.4065/70.8.734. [DOI] [PubMed] [Google Scholar]
  2. Blumer D., Montouris G., Hermann B. Psychiatric morbidity in seizure patients on a neurodiagnostic monitoring unit. J Neuropsychiatry Clin Neurosci. 1995 Fall;7(4):445–456. doi: 10.1176/jnp.7.4.445. [DOI] [PubMed] [Google Scholar]
  3. Burnam M. A., Hough R. L., Escobar J. I., Karno M., Timbers D. M., Telles C. A., Locke B. Z. Six-month prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles. Arch Gen Psychiatry. 1987 Aug;44(8):687–694. doi: 10.1001/archpsyc.1987.01800200013003. [DOI] [PubMed] [Google Scholar]
  4. Choppy-Jacolin M., Ferrey G., Demaria C. A psychometric stury of 34 patients afflicted with spasmodic torticollis. Acta Neurol Scand. 1977 Jun;55(6):483–492. doi: 10.1111/j.1600-0404.1977.tb07627.x. [DOI] [PubMed] [Google Scholar]
  5. Dauer W. T., Burke R. E., Greene P., Fahn S. Current concepts on the clinical features, aetiology and management of idiopathic cervical dystonia. Brain. 1998 Apr;121(Pt 4):547–560. doi: 10.1093/brain/121.4.547. [DOI] [PubMed] [Google Scholar]
  6. George M. S., Lydiard R. B. Social phobia secondary to physical disability. A review of benign essential tremor (BET) and stuttering. Psychosomatics. 1994 Nov-Dec;35(6):520–523. doi: 10.1016/s0033-3182(94)71720-5. [DOI] [PubMed] [Google Scholar]
  7. Guidetti V., Galli F., Fabrizi P., Giannantoni A. S., Napoli L., Bruni O., Trillo S. Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study. Cephalalgia. 1998 Sep;18(7):455–462. doi: 10.1046/j.1468-2982.1998.1807455.x. [DOI] [PubMed] [Google Scholar]
  8. Jahanshahi M., Marsden C. D. Depression in torticollis: a controlled study. Psychol Med. 1988 Nov;18(4):925–933. doi: 10.1017/s0033291700009855. [DOI] [PubMed] [Google Scholar]
  9. Jahanshahi M., Marsden C. D. Personality in torticollis: a controlled study. Psychol Med. 1988 May;18(2):375–387. doi: 10.1017/s0033291700007923. [DOI] [PubMed] [Google Scholar]
  10. Jahanshahi M., Marsden C. D. Psychological functioning before and after treatment of torticollis with botulinum toxin. J Neurol Neurosurg Psychiatry. 1992 Mar;55(3):229–231. doi: 10.1136/jnnp.55.3.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jahanshahi M. Psychosocial factors and depression in torticollis. J Psychosom Res. 1991;35(4-5):493–507. doi: 10.1016/0022-3999(91)90044-o. [DOI] [PubMed] [Google Scholar]
  12. Magee W. J., Eaton W. W., Wittchen H. U., McGonagle K. A., Kessler R. C. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry. 1996 Feb;53(2):159–168. doi: 10.1001/archpsyc.1996.01830020077009. [DOI] [PubMed] [Google Scholar]
  13. Marsden C. D. The problem of adult-onset idiopathic torsion dystonia and other isolated dyskinesias in adult life (including blepharospasm, oromandibular dystonia, dystonic writer's cramp, and torticollis, or axial dystonia). Adv Neurol. 1976;14:259–276. [PubMed] [Google Scholar]
  14. Matthews W. B., Beasley P., Parry-Jones W., Garland G. Spasmodic torticollis: a combined clinical study. J Neurol Neurosurg Psychiatry. 1978 Jun;41(6):485–492. doi: 10.1136/jnnp.41.6.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Meares R. Features which distinguish groups of spasmodic torticollis. J Psychosom Res. 1971 Mar;15(1):1–11. doi: 10.1016/0022-3999(71)90067-5. [DOI] [PubMed] [Google Scholar]
  16. Mitscherlich M. The theory and therapy of hyperkineses (torticollis). Psychother Psychosom. 1979;32(1-4):306–312. doi: 10.1159/000287401. [DOI] [PubMed] [Google Scholar]
  17. Oberlander E. L., Schneier F. R., Liebowitz M. R. Physical disability and social phobia. J Clin Psychopharmacol. 1994 Apr;14(2):136–143. [PubMed] [Google Scholar]
  18. Rondot P., Marchand M. P., Dellatolas G. Spasmodic torticollis--review of 220 patients. Can J Neurol Sci. 1991 May;18(2):143–151. doi: 10.1017/s0317167100031619. [DOI] [PubMed] [Google Scholar]
  19. Scheidt C. E. Klinische und psychometrische Befunde beim spasmodischen Tortikollis. Psychother Psychosom Med Psychol. 1995 May;45(5):183–191. [PubMed] [Google Scholar]
  20. Spitzer R. L., Williams J. B., Gibbon M., First M. B. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry. 1992 Aug;49(8):624–629. doi: 10.1001/archpsyc.1992.01820080032005. [DOI] [PubMed] [Google Scholar]
  21. Stein M. B., Baird A., Walker J. R. Social phobia in adults with stuttering. Am J Psychiatry. 1996 Feb;153(2):278–280. doi: 10.1176/ajp.153.2.278. [DOI] [PubMed] [Google Scholar]
  22. Stein M. B., Heuser I. J., Juncos J. L., Uhde T. W. Anxiety disorders in patients with Parkinson's disease. Am J Psychiatry. 1990 Feb;147(2):217–220. doi: 10.1176/ajp.147.2.217. [DOI] [PubMed] [Google Scholar]
  23. Stein M. B., Walker J. R., Forde D. R. Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety. Am J Psychiatry. 1994 Mar;151(3):408–412. doi: 10.1176/ajp.151.3.408. [DOI] [PubMed] [Google Scholar]
  24. Tsui J. K., Eisen A., Stoessl A. J., Calne S., Calne D. B. Double-blind study of botulinum toxin in spasmodic torticollis. Lancet. 1986 Aug 2;2(8501):245–247. doi: 10.1016/s0140-6736(86)92070-2. [DOI] [PubMed] [Google Scholar]
  25. Waddell G. Low back disability. A syndrome of Western civilization. Neurosurg Clin N Am. 1991 Oct;2(4):719–738. [PubMed] [Google Scholar]
  26. Wenzel T., Schnider P., Wimmer A., Steinhoff N., Moraru E., Auff E. Psychiatric comorbidity in patients with spasmodic torticollis. J Psychosom Res. 1998 Jun;44(6):687–690. doi: 10.1016/s0022-3999(97)00229-8. [DOI] [PubMed] [Google Scholar]
  27. Williams J. B., Gibbon M., First M. B., Spitzer R. L., Davies M., Borus J., Howes M. J., Kane J., Pope H. G., Jr, Rounsaville B. The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Arch Gen Psychiatry. 1992 Aug;49(8):630–636. doi: 10.1001/archpsyc.1992.01820080038006. [DOI] [PubMed] [Google Scholar]
  28. Wittchen H. U., Essau C. A., von Zerssen D., Krieg J. C., Zaudig M. Lifetime and six-month prevalence of mental disorders in the Munich Follow-Up Study. Eur Arch Psychiatry Clin Neurosci. 1992;241(4):247–258. doi: 10.1007/BF02190261. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES