Obsessive‐compulsive symptoms in primary focal dystonia: A controlled study

Abstract

Primary focal dystonia is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology probably involves the basal ganglia and cortical-basal pathways. Primary dystonia appears to be associated with significant obsessive-compulsive symptoms, but evidence remains scarce and contradictory. We addressed the following research questions: (1) Do primary dystonia patients have high obsessive-compulsive symptom scores? (2) Are these symptoms more severe in dystonia than in controls with equivalent peripheral neurological disorders? and (3) Is psychopathology different in botulinum toxin-treated and -untreated dystonia patients? This work was a cross-sectional, descriptive, controlled study comprising 45 consecutive patients with primary focal dystonia (i.e., blepharospasm, spasmodic torticollis, or writer's cramp) 46 consecutive patients with hemifacial spasm, cervical spondylarthropathy, or carpal tunnel syndrome, and 30 healthy volunteers. Assessment included the DSM-IV based psychiatric interview, Symptom Checklist 90R, Yale-Brown Obsessive-Compulsive Scale and Checklist, and the Unified Dystonia Rating Scale. Dystonia patients had higher Yale-Brown Obsessive-Compulsive Symptom scores than both control groups. Dystonia patients with obsessive-compulsive symptom scores above cut-off for clinical significance predominantly developed hygiene-related symptoms. Major depression and generalized anxiety disorder were the most frequent psychiatric diagnoses in primary focal dystonia. Obsessive-compulsive disorder frequency was 6.7%. Primary focal dystonia patients have higher obsessive-compulsive symptom scores than individuals with similar functional disabilities resulting from other neurological disorders, suggesting that obsessive-compulsive symptoms in dystonia are not reactive to chronic disability. Dystonic muscle contractions and obsessive-compulsive symptoms may share a common neurobiological basis related to cortical-basal dysfunction. Psychopathology, especially obsessive-compulsive symptoms, should be actively explored and treated in primary focal dystonia.

Improvement of Orbitofrontal Cortex Function Associated with Blephrospasm Symptom Remission

“…The lateral OFC mediates response inhibition, which is important in OCD [19]. Several studies have identified an increased frequency of OCD symptoms in BSP patients [20,21]. These findings may explain the higher Y-BOCS scores in the 2 BSP patient groups compared with the HC group.…”

Cognition and psychopathology in myoclonus-dystonia

“…Fabbrini et al 54 found that depressive disorders were most common in primary focal dystonia, and that in the majority of their patients, psychiatric diagnosis developed before onset of motor symptoms, suggesting it to be part of the disease. By contrast, it was shown that depressive symptoms improved with botulinum toxin treatment, suggesting a more psycho-reactive mechanism 40 55. The fact that the origin of depression seems to be more reactive compared with anxiety is suggested by the median age of onset of anxiety (11 years) versus mood disorders (30 years) in the general population 56.…”

Blepharospasm 40 years later

“…In contrast, 2 smaller studies failed to detect any risk for depressive symptoms . Of the 6 controlled studies, 3 detected a higher risk of obsessive/compulsive symptoms in patients with blepharospasm than in disease‐affected and healthy controls using different psychiatric tools (Table ). Yet another study on 76 patients with mixed types of isolated focal dystonia (including 50 patients with blepharospasm) was not considered in our analysis because data could not be extracted for patients with blepharospasm alone .…”