Table 1.
Depression/anxiety studies in dystonia
| Author, Year | Study Type | Sample Size | Findings | Comments |
|---|---|---|---|---|
| Aronson, 1968 | Case control | 31 spasmodic dysphonia 50000 controls (gen. outpt medical population) 18 psychogenic aphonia |
No statistically significant difference between the 3 groups on MMPI. | |
| Van Hoof, 1987 | Retrospective Case Control | 17 spasmodic torticollis Healthy controls (Unspecified) |
No difference in personality inventory. 2 of 17 spasmodic torticollis patients had depression. | |
| Harrington, 1988 | Retrospective Case Control | 22 writer’s cramp 22 healthy controls |
No difference in anxiety indices. 3 subjects had symptoms of generalized anxiety. | |
| Naber, 1988 | Case Control | 32 spasmodic torticollis 32 controls with Parkinson disease |
MMPI scores, specifically hypochondriasis, depression, and hysteria, were elevated in 50% of pts. | MMPI scores correlated with severity of neurologic symptoms and were similar to PD controls. |
| Jahanshahi, 1988b | Case control | 100 spasmodic torticollis 49 controls (cervical spondylosis) |
No difference in MMPI, anxiety or obsessive symptoms. | 7 ST patients with prior psychiatric histories were excluded. |
| Jahanshahi, 1989 | Case series | 61 spasmodic torticollis | 36% had normal MMPI profiles, conversion “V” profiles were seen in 9%. | 58.5% had MMPI pattern consistent with mild depression |
| Jahanshahi, 1990a | 2 year Longitudinal cohort | 67 spasmodic torticollis | 25% of patients depressed at both time points. | Depression improved in patients with successful botox treatment. |
| Jahanshahi, 1990b and Jahanshahi, 1988a | Retrospective case control | 85 spasmodic torticollis 49 controls (cervical spondylosis) |
ST patients had higher prevalence (54%) and severity of depression, disability and negative body concept. | Body image, neuroticism, pain and disability correlated with depression. |
| Grafman, 1991 | Case series | 20 focal hand dystonia | 4/20 had mild depression, 30% with elevated anxiety inventory scores. | MMPI and psychiatric histories were unremarkable and did not correlate with dystonia severity. |
| Cannito, 1991 | Retrospective case control | 18 spasmodic dysphonia 18 healthy controls |
SD had higher rates of clinical depression and anxiety (both 39%). | |
| Jahanshahi, 1992 | Longitudinal cohort | 26 spasmodic torticollis | Improved depression and disability after botox injections in 22 pts whose torticollis improved. | Body concept also improved but not significantly |
| Murry, 1994 | Case control | 32 spasmodic dysphonia 28 healthy controls |
SD had higher ratings of depression, state and trait anxiety. | Improvements noted in depression and anxiety following botox treatment. |
| Scheidt, 1996 I–IV | Retrospective case control | 256 spasmodic torticollis HC (Unspecified) |
27% of ST patients had psychopathology including 23% with clinical depression. | Depression correlated with severity. |
| Wenzel, 1998 | Case series | 44 spasmodic torticollis | High lifetime prevalence of psychiatric disorders (66%) especially anxiety disorders (34%), including panic disorder (20%) and MDD (25%). | 43% of patients reported psychopathology preceded motor symptoms. |
| Gundel, 2001 | Case control | 116 spasmodic torticollis 483 healthy controls |
Higher lifetime prevalence of MDD (46%) and anxiety d/o, especially social phobia (71%) | Psychopathology did not correlate with dystonia severity. Social phobia correlated with body image. |
| Moraru, 2002 | Case series | 40 spasmodic torticollis | 40% with anxiety, 37.5% with major depressive disorder. | Criteria for 1 lifetime psychiatric dx fulfilled prior to onset of ST in 42.5% |
| Muller, 2002 | Longitudinal cohort | 131 spasmodic torticollis 89 blepharospasm |
47% depression in ST pts, 37% in BL pts. Health related QOL significantly worse in all domains compared to controls. | Botox improved clinical symptoms but minimal improvement in health related QOL. |
| Gundel, 2003 | Retrospective case control | 48 spasmodic torticollis 48 controls (alopecia areata) |
Higher prevalence of psychiatric diagnosis (77%) including anxiety (69%) and mood (19%) disorders. | Social phobia (54%) was the most common anxiety disorder |
| Heiman, 2004 | Case control | 96 manifesting carriers of DYT1 60 non-manifesting carriers of DYT1 65 noncarriers |
Risk for recurrent major depressive disorder increased in both NMC (RR 4.95) and MC (RR 3.62) compared with noncarriers | Mutation carriers also had earlier onset depression than noncarriers |
| Lauterbach, 2004 | Retrospective case control | 28 primary generalized dystonia and spasmodic torticollis 1:128 matching with healthy controls |
Higher prevalence of MDD (25%), BMD (7%), phobias (39%), GAD (25%) and alcohol abuse (11%) than in HC. | 53% of dystonia patients were on GABA agonists. Phobias and GAD frequently preceded motor symptoms. |
| Lewis, 2008 | Case series | 329 focal and generalized dystonia | 30% reported moderate to severe depression. Disfigurement, negative body concept, low self- esteem, and QOL were important contributors to depression. |
BL – blepharospasm; BMD – bipolar mood disorder; FHD – focal hand dystonia; GAD – generalized anxiety disorder; HC – healthy controls; MC – manifesting carriers; MDD – major depressive disorder; MMPI – Minnesota Multiphasic Personality Inventory; NMC – nonmanifesting carriers; PA – psychogenic aphonia; PD – Parkinson disease; PG – primary generalized dystonia; QOL – quality of life; SD – spasmodic dysphonia; ST – spasmodic torticollis; WC – writer’s cramp