Psychiatric co-morbidity is highly prevalent in idiopathic cervical dystonia and significantly influences health-related quality of life: Results of a controlled study.
The aim of this study was to systematically investigate the prevalence of psychiatric disorders and factors influencing health-related quality of life (HR-QoL) in cervical dystonia (CD) patients, in the context of objective dystonia motor severity.



We studied 50 CD patients and 50 matched healthy controls. Psychiatric assessment included the MINI-PLUS interview and quantitative questionnaires. Dystonia motor severity (based on video evaluation), pain and disability were determined with the TWSTRS rating scale. In addition, severity of tremor and jerks was evaluated with the 7-point CGI-S scale. HR-QoL was determined with the RAND-36 item Health Survey and predictors of HR-QoL were assessed using multiple regression analysis.



In CD patients, the MINI-PLUS revealed a significantly higher prevalence of psychiatric disorders (64% vs. 28%, p = 0.001), with substantially more depression (32% vs. 14%) and anxiety disorders (42% vs. 8%). This was confirmed by the quantitative rating scales. Disease characteristics did not differ between patients with and without a psychiatric diagnosis. HR-QoL in dystonia patients was significantly lowered. The most important predictors of HR-QoL appeared severity of depressive symptoms, pain and disability, but not severity of motor symptoms.



Psychiatric co-morbidity is highly prevalent and is an important predictor of HR-QoL in CD patients, rather than dystonia motor severity. Our findings support the theory of a shared neurobiology for motor and non-motor features and highlight the need for systematic research into psychiatric disorders in dystonia. Adequate treatment of psychiatric symptoms could significantly contribute to better overall quality of life of CD patients.
University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: m.smit03@umcg.nl.
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Smit
University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: a.kuiper@umcg.nl.
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Kuiper
Department of Neurology, Safarik University, Hlavna 83/81, 04001 Kosice, Slovakia; Department of Neurology, University Hospital L. Pasteur, Kosice, Slovakia. Electronic address: vladimir.han@gmail.com.
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Han
University of Groningen, University Medical Center Groningen, Department of Psychiatry, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: v.c.r.jiawan@umcg.nl.
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Jiawan
Martini Hospital, Department of Neurology, PO Box 30.033, 9700 RM Groningen, The Netherlands. Electronic address: g.douma@mzh.nl.
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Douma
Medical Center Leeuwarden, Department of Neurology, PO Box 888, 8901 BR Leeuwarden, The Netherlands. Electronic address: barbera.van.harten@znb.nl.
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van Harten
Antonius Hospital, Department of Neurology, PO Box 20.000, 8600 BA Sneek, The Netherlands. Electronic address: j.oen@antonius-sneek.nl.
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Oen
Scheper Hospital, Department of Neurology, PO Box 30.002, 7800 RA Emmen, The Netherlands. Electronic address: e.pouwels@treant.nl.
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Pouwels
Röpcke-Zweers Hospital, Department of Neurology, PO Box 1, 7770 AA Hardenberg, The Netherlands. Electronic address: h.dieks@sxb.nl.
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Dieks
University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700 RB Groningen, The Netherlands; Ommelander Hospital Group, Department of Neurology, PO Box 30.000, 9930 RA Delfzijl, The Netherlands. Electronic address: a.l.bartels@umcg.nl.
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Bartels
University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: m.a.j.de.koning-tijssen@umcg.nl.
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Tijssen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D020821:Dystonic Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
Dystonia; Health-related quality of life; Non-motor; Psychiatry