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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. 1Children's Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2Department of Child and Adolescent Mental Health, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
  3. 3Great Ormond Street Hospital for Children, London, UK
  4. 4Kids Rehabilitation Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
  5. 5The University of Sydney, Sydney, New South Wales, Australia
  6. 6Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
  7. 7University College Dublin School of Medicine and Medical Science, Dublin, Ireland
  8. 8The Neurodisability Service, Great Ormond Street Hospital fro Children, London, UK
  9. 9Child and Adolescent Psychiatry, Institute of Psychiatry, London, UK
  10. 10Neurosciences, 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}health.nsw.gov.au

Abstract

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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Footnotes

  • Twitter @lilkatg

  • 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.

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