Substance abuse in cervical dystonia
Mahajan A, Jankovic J, Marsh L, Patel A, and Patel N. Substance abuse in cervical dystonia. Mov Disord 2017; 32(9):e16.
Objective: To assess the prevalence of substance abuse (SA) in cervical dystonia (CD) patients and correlation with psychiatric symptoms. Background: CD patients have a higher frequency of psychiatric disorders compared to healthy controls. Medications such as benzodiazepines, muscle relaxants and opiates, often used in the management of CD, are habit-forming and may lead to SA. Methods: Data collected from 10 sites participating in the Dystonia Coalition (htts://clinicaltrials.gov/show/NCT01373424) included individual responses to Hospital Anxiety and Depression Scale (HADS), Beck Depression Index II (BID-II) and Patient Health Questionaire-9 (PHQ9). These responses were correlated with clinical assessments of CD using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Structured Clinical Interview for DSM (SCID). Patients were divided into two groups based on the presence of SA, utilizing SCID criteria. Wilcoxon Rank-Sum test was used to analyze the difference in median scores on the questionnaires between the groups. A two-tailed p-value of <0.05 was considered significant. Results: Of 208 CD patients enrolled, 23 (11%) were identified with SA. Of the male CD patients, 23% were identified with SA compared to 6.58% among female CD patients (p5 0.0007). The median age was 55 years in the SA group versus 61 in the other (p5 0.0315). Compared to those without SA, SA patients scored higher on PHQ9 (Median score 5 vs 3, P50.0437), BDI-II score (Median score 11 vs 7, P50.005), HADS total score (Median score 13 vs 9, P50.0035) and TWSTRS total psych (Median score 5 vs 3, P50.0335). Conclusions: Potential risk factors for SA in CD include younger age and male gender. The SA CD patients are more likely to appear to have co-morbid anxiety and depression. Patients with CD, particularly young males with associated psychiatric disorders, should be carefully monitored for potential SA.