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Psychiatric comorbidity is common in dystonia and other movement disorders
  1. Michelle S Lorentzos1,
  2. Isobel Heyman2,
  3. Benjamin J Baig2,
  4. Anna E Coughtrey3,
  5. Andrew McWilliams2,
  6. David R Dossetor1,
  7. Mary-Clare Waugh4,
  8. Ruth A Evans1,
  9. Josie Hollywood2,
  10. Joshua Burns5,
  11. Manoj P Menezes1,
  12. Shekeeb S Mohammad1,
  13. Padraig Grattan-Smith5,
  14. Kathleen M Gorman6,7,
  15. Belinda H A Crowe8,
  16. Robert Goodman9,
  17. Manju A Kurian10,
  18. Russell C Dale1,5
  1. 1 Children's Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2 Department of Child and Adolescent Mental Health, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
  3. 3 Great Ormond Street Hospital for Children, London, UK
  4. 4 Kids Rehabilitation Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
  5. 5 The University of Sydney, Sydney, New South Wales, Australia
  6. 6 Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
  7. 7 University College Dublin School of Medicine and Medical Science, Dublin, Ireland
  8. 8 The Neurodisability Service, Great Ormond Street Hospital fro Children, London, UK
  9. 9 Child and Adolescent Psychiatry, Institute of Psychiatry, London, UK
  10. 10 Neurosciences, UCL-Institute of Child Health, London, UK
  1. Correspondence to Dr Russell C Dale, Children's Hospital at Westmead, Westmead, NSW 2145, Australia; russell.dale{at}


Objective To determine rates of psychiatric comorbidity in a clinical sample of childhood movement disorders (MDs).

Design Cohort study.

Setting Tertiary children’s hospital MD clinics in Sydney, Australia and London, UK.

Patients Cases were children with tic MDs (n=158) and non-tic MDs (n=102), including 66 children with dystonia. Comparison was made with emergency department controls (n=100), neurology controls with peripheral neuropathy or epilepsy (n=37), and community controls (n=10 438).

Interventions On-line development and well-being assessment which was additionally clinically rated by experienced child psychiatrists.

Main outcome measures Diagnostic schedule and manual of mental disorders-5 criteria for psychiatric diagnoses.

Results Psychiatric comorbidity in the non-tic MD cohort (39.2%) was comparable to the tic cohort (41.8%) (not significant). Psychiatric comorbidity in the non-tic MD cohort was greater than the emergency control group (18%, p<0.0001) and the community cohort (9.5%, p<0.00001), but not the neurology controls (29.7%, p=0.31). Almost half of the patients within the tic cohort with psychiatric comorbidity were receiving medical psychiatric treatment (45.5%) or psychology interventions (43.9%), compared with only 22.5% and 15.0%, respectively, of the non-tic MD cohort with psychiatric comorbidity.

Conclusions Psychiatric comorbidity is common in non-tic MDs such as dystonia. These psychiatric comorbidities appear to be under-recognised and undertreated.

  • psychology
  • neurology

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  • Funding JB is funded by the Australian Department of Health (Medical Research Future Fund), US National Institutes of Health, Charcot-Marie Tooth Association of Australia, Charcot-Marie Tooth Association (USA), Diabetes Australia, Elizabeth Lottie May Rosenthal Bone Bequest, Perpetual Limited, Humpty Dumpty Foundation. Consultancies: Pharnext SA, Charcot Marie Tooth Association (USA) Advisory Board (Clinical Experts), Research & Innovation Advisory Board, Siriraj Hospital, Mahidol University, Bangkok, Thailand

  • Competing interests RG and his family are the owners of Youthinmind Limited, which provides no-cost and low-cost measures of child mental health, including the Strengths and Difficulties Questionnaire (SDQ) and development and well-being assessment (DAWBA).

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was received from the institutional review board (11CHW14).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.