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Depression in focal, segmental and generalized dystonia

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Abstract

Dystonia causes body disfigurement in the majority of those affected. Our aim was to test the hypothesis that low self-esteem resulting from the sense of disfigurement is an important component of self-reported depression in focal, segmental and generalized dystonia. Questionnaires to assess self-reported depression, self-esteem, body concept, disfigurement, disability and quality of life were completed by 329 community based dystonia patients. Moderate to severe depression was reported by 30 %. Self-reported depression had a strong somatic component, but patients also showed a specific concern with self-image. Extent of dystonia, body parts affected and marital status influenced self-reported depression in dystonia. Selfesteem, body concept, disfigurement and quality of life emerged as factors which accounted for the variance of self-reported depression in dystonia. These results suggest that in dystonia, disfigurement, negative body concept, low self-esteem, and the impact of the disease on quality of life make important contributions to depression. However, longitudinal followup is required to firmly establish the direction of causality between depression and these psychosocial variables in dystonia.

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References

  1. Marsden CD, Harrison MJG (1974) Idiopathic torsion dystonia (dystonia musculorum deforams). A review of forty-two patients. Brain 30:623–631

    Google Scholar 

  2. Fahn S, Marsden CD, Calne DB (1987) Classification and investigation of dystonia. In: Marsden CD, Fahn S (eds) Movement disorders 2. London: Buttersworth, pp 332–358

  3. Jahanshahi M (2005) Behavioural and psychiatric manifestations in Dystonia. In: Anderson K, Weiner, W, Lang A (eds) Advances in Neurology Series. Behavioural Neurology of Movement Disorders, 2nd Edition. Williams & Wilkins

  4. Jahanshahi M, Marsden CD (1988) Depression in torticollis: A controlled study. Psychol Med 18:925–933

    PubMed  CAS  Google Scholar 

  5. Naber D, Winberger DR, Bullionger M, et al. (2002) Personality variables, neurological and psychopathological symptoms in patients suffering from spasmodic torticollis. Compr Psychiatr 29:182–187

    Article  Google Scholar 

  6. Bihari K, Hill JL, Murphy DL (1992) Obsessive-compulsive characteristics in patients with idiopathic torticollis. Psychiatr Res 42:267–272

    Article  CAS  Google Scholar 

  7. Wenzel T, Schnider P, Wimmer A, et al. (1998) Psychiatric comorbidity in patients with spasmodic torticollis. J Psychosom Res 44:687–690

    Article  PubMed  CAS  Google Scholar 

  8. Moraru E, Schider P, Wimmer A, et al. (2002) Relation between depression and anxiety in dystonic patients. Implications for clinical management. Depress Anxiety 16:100–103

    Article  PubMed  CAS  Google Scholar 

  9. Gundel H, Wolf A, Xidara V, et al. (2001) Social phobia in spasmodic torticollis. J Neurol Neurosurg Psychiatr 71:499–504

    Article  PubMed  CAS  Google Scholar 

  10. Cavallaro R, Galardi G, Cavallini CM, et al. (2002) Obsessive compulsive disorder among idiopathic focal dystonia patients: an epidemiological and family study. Biol Psychiatr 52:356–361

    Article  Google Scholar 

  11. Grafman J, Cohen L, Hallett M (1991) Is focal hand dystonia associated with psychopathology? Mov Disord 6:29–35

    Article  PubMed  CAS  Google Scholar 

  12. Bindman E, Tibbets RE (1977) Writer’s cramp, a rational approach to treatment. Br J Psychiatr 131:143–148

    Article  CAS  Google Scholar 

  13. Broocks A, Thiel A, Angerstein D, et al. (1988) Higher prevalence of obsessivecompulsive symptoms in patients with blepharospasm than in patients with hemi-facial spasm. Am J Psychiatr 155:555–557

    Google Scholar 

  14. Whurr R, Lorch M, Lindsay M, et al. (1998) Psychological function in spasmodic dysphonia before and after treatment with botulinum toxin. J Med Speech-Lang Pathol 6:81–91

    Google Scholar 

  15. Harris DL (1982) The symptomatology of abnormal appearance: an anecdotal survey. Br J Plast Surg 35:312–323

    PubMed  CAS  Google Scholar 

  16. Green BC, Pratt CC, Grisby TE (1984) Self-concept among patients with long-term spinal cord injury. Arch Phys Med Rehabil 65:751–754

    PubMed  CAS  Google Scholar 

  17. Antle BJ (2004) Factors associated with self-worth in young people with physical disabilities. Health Soc Work 29:167–175

    PubMed  Google Scholar 

  18. Jahanshahi M, Marsden CD (1990) Body concept, depression and disability in spasmodic torticollis. Behav Neurol 3:117–131

    Google Scholar 

  19. Duffey PO, Butler AG, Hawthorne MR, et al. (1998) The epidemiology of the primary dystonias in the North of England. Adv Neurol 78:121–125

    PubMed  CAS  Google Scholar 

  20. Beck AT, Ward CH, Mendleson M, et al. (1961) An inventory for measuring depression. Arch Gen Psychiatr 4:561–571

    PubMed  CAS  Google Scholar 

  21. Ware JE, Sherbourne CD (1992) The MOS 36-Item short-form health survey 1: conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  22. Brazier JE, Harper R, Jones NMB, et al. (1992) Validating the SF-36 Health survey questionnaire: new outcome measure for primary care. Br Med J 305:160–164

    CAS  Google Scholar 

  23. Garatt AM, Ruta DA, Abdalla MI, et al. (1993) The SF-36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? Br Med J 306:1440–1444

    Article  Google Scholar 

  24. EuroQol Group (1990) EuroQol: a new facility for the measurement of healthrelated quality of life. Health Pol 16:199–208

    Google Scholar 

  25. Kind P, Dolan P, Gudex C, et al. (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. Br Med J 316:736–741

    CAS  Google Scholar 

  26. Van Agt H, Essink-Bot M-L, Krabbe P, et al. (1994) Test-retest reliability of health state valuations collected with the EuroQol questionnaire. Soc Sci Med 11:1537–1544

    Article  Google Scholar 

  27. Rosenberg MI (1965) Society and the Adolescent Self-Image. Princeton: Princeton University Press

  28. Schrag A, Jahanshahi M, Quinn N (2001) What contributes to quality of life in parkinson’s disease? Psychol Med 31:65–73

    Article  PubMed  CAS  Google Scholar 

  29. Chwastiak L, Ehde D, Gibbons LE, et al. (2002) Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am Psychiatr Assoc 159:1862–1869

    Google Scholar 

  30. Beck AT (1970) Depression. Philadelphia: University of Pennysylvania Press

  31. Mirabel-Sarron C, Vera L, Samuel- Lajeunesse B (2001) Self-esteem and depression. Annales medico-psychologiques, revue psychiatrique 159:144–148

  32. Papathanasiou I, MacDonald L, Whurr R, et al. (1997) Perceived stigma among patients with spasmodic dysphonia. J Med Speech-Lang Pathol 5:251–261

    Google Scholar 

  33. Papathanasiou I, MacDonald L, Whurr R, et al. (2001) Perceived stigma in spasmodic torticollis. Mov Disord 16:280–285

    Article  PubMed  CAS  Google Scholar 

  34. Ben-Shlomo Y, Camfield L, Warner T, et al. (2002) What are the determinants of quality of life in people with cervical dystonia? J Neurol Neurosurg Psychiatry 72:608–614

    Article  PubMed  CAS  Google Scholar 

  35. Jahanshahi M, Marsden CD (1992) Psychological functioning before and after treatment of torticollis with botulinum toxin. J Neurol Neurosurg Psychiatry 55:229–231

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Cognitive-Motor Neuroscience Group, Sobell Department of Motor Neuroscience & Movement Disorders, Institute of Neurology & The National Hospital for Neurology & Neurosurgery, Queen Square, London, WC1N 3BG, UK

    L. Lewis &  M. Jahanshahi

  2. Dystonia Epidemiologist, Hunters Moor Regional Rehabilitation Centre, Hunters Road, Newcastle, NE2 4NR, UK

    A. Butler

Authors
  1. L. Lewis
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  2. A. Butler
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  3. M. Jahanshahi
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Correspondence to M. Jahanshahi.

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Lewis, L., Butler, A. & Jahanshahi, M. Depression in focal, segmental and generalized dystonia. J Neurol 255, 1750–1755 (2008). https://doi.org/10.1007/s00415-008-0020-x

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  • DOI: https://doi.org/10.1007/s00415-008-0020-x

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