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Author Notes:

Correspondence to Dr. Brian D Berman, Department of Neurology, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Mail Stop B-185, Aurora 80045, Colorado, USA; brian.berman@ucdenver.edu

Contributors: BDB: Project conception, design, organisation and execution; recruitment and clinical assessment of subjects; statistical analysis design and oversight; manuscript drafting and revision.

JJ: Project conception, design and organisation; manuscript review and critique.

ES: Recruitment and clinical assessment of subjects.

SHS: Statistical analysis design and execution.

HAJ, JSP, AJE, JJ, MV, CB, WO, IAM, RR, TB: Recruitment and clinical assessment of subjects; manuscript review and critique.

WMM, LM, MZ: Neuropsychiatric scale selection; manuscript review and critique.

NB: Project conception, design and organisation; recruitment and clinical assessment of subjects; manuscript review and critique.

We would like to thank Laura J Wright, MA, for her assistance with accessing the Dystonia Coalition database and Ami R Rosen, MS, for providing organisational support for the Dystonia Coalition.

Competing interests: None declared.

Patient consent: All patients consent with local IRB-approved consent forms.

Ethics approval: Internal Review Boards for all participating clinical sites.


Research Funding:

This study was supported by a grant from the National Institutes of Health (Dystonia Coalition U54 NS065701).

This work was supported in part by grants to the Dystonia Coalition (U54NS065701/TR001456), a consortium of the Rare Diseases Clinical Research Network (RDCRN) that is supported by the Office of Rare Diseases Research (ORDR) at the National Center for Advancing Clinical and Translational Studies (NCATS) in collaboration with the National Institute for Neurological Diseases and Stroke (NINDS).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Psychiatry
  • Surgery
  • Neurosciences & Neurology
  • Isolated focal dystonia
  • Anxiety
  • Depression
  • Pain

Psychiatric associations of adult-onset focal dystonia phenotypes

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Journal Title:

Journal of Neurology, Neurosurgery and Psychiatry


Volume 88, Number 7


, Pages 595-602

Type of Work:

Article | Final Publisher PDF


Background Depression and anxiety frequently accompany the motor manifestations of isolated adult-onset focal dystonias. Whether the body region affected when this type of dystonia first presents is associated with the severity of these neuropsychiatric symptoms is unknown. Objectives The aim of this study was to determine whether depression, anxiety and social anxiety vary by dystonia onset site and evaluate whether pain and dystonia severity account for any differences. Methods patients with isolated focal dystonia evaluated within 5 years from symptom onset, enrolled in the Natural history project of the Dystonia coalition, were included in the analysis. Individual onset sites were grouped into five body regions: cervical, laryngeal, limb, lower cranial and upper cranial. Neuropsychiatric symptoms were rated using the Beck Depression Inventory, hospital anxiety and Depression scale and Liebowitz social anxiety scale. pain was estimated using the 36-Item short Form survey. results Four hundred and seventy-eight subjects met our inclusion criteria. high levels of depression, anxiety and social anxiety occurred in all groups; however, the severity of anxiety and social anxiety symptoms varied by onset site group. The most pronounced differences were higher anxiety in cervical and laryngeal, lower anxiety in upper cranial and higher social anxiety in laryngeal. Increases in pain were associated with worse neuropsychiatric symptom scores within all groups. higher anxiety and social anxiety in laryngeal and lower anxiety in upper cranial persisted after correcting for pain and dystonia severity. Conclusion anxiety and social anxiety severity vary by onset site of focal dystonia, and this variation is not explained by differences in pain and dystonia severity.

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© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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