Is there a specific psychiatric background or personality profile in functional dystonia?

OBJECTIVE: The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic ("primary") dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits. METHODS: Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory). RESULTS: Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences. CONCLUSION: Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.

Efficacy of botulinum toxin type A in treatment of different forms of focal dystonias in the Serbian population: experience of the Botulinum Toxin Outpatients Department.

BACKGROUND/AIM: Botulinum toxin (BTX) irreversibly inhibits presynaptic acetylcholine release with subsequent relaxation of abnormally contracting muscles. It is an effective and well tolerated treatment with long-term benefit in a variety of movement disorders and other neurological and non-neurological disturbances. The aim of our study was to present our experience with BTX type A in treatment of different forms of focal dystonias. METHODS: A hundred of patients with different focal dystonias (spastic torticollis, blepharospasm and graphospasm) from the Botulinum Toxin Outpatients Department, Clinic for Neurology, Clinical Center of Serbia, were included in the study. All the patients were examined and rated at baseline visit prior to BTX application and on the following visit, after 3-4 months, using self-assessment improvement questionnaire and standardized rating scales. RESULTS: . The improvement of 50% was presented in 68.2% of all (199) the analyzed applications. Independent predictors of good response to the therapy (improvement ≥ 50%) were male sex (p = 0.011), the presence of sensory trick (p = 0.013) and the total number of BTX applications (p = 0.002). The patients with spastic torticollis and blepharospasm showed a statistically significantly better BTX effect (improvement 57.3 ± 27.5% and 54.1 ± 28.3%), respectively than the graphospasm group (26.7 ± 25.6%). Most of the patients did not have therapy complications (81.4% and 72% in two applications). Side effects in the remaining patients (muscle weakness, dysphagia, ptosis, double vision, neck weakness and lacrimal dysfunction) lasted for 28.3 ± 18.6 days after the first treatment and 32.5 ± 36.2 days after the second one. CONCLUSION: BTX is safe and highly effective in long-term treatment of patients with different forms of focal dystonia, with only mild and well-tolerated side-effects.