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Title: Mental health and behaviour in childhood dystonia
Author: Bates, Lauren
ISNI:       0000 0004 8500 4448
Awarding Body: Royal Holloway, University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2018
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Dystonia is a movement disorder in which "sustained or intermittent involuntary muscle contractions cause twisting or repetitive movements or abnormal postures" (Sanger, 2003, p. 1509) which impact everyday functioning. The biopsychosocial model suggests that the interrelation of biological, psychological and social factors impact overall health and wellbeing. Studies have shown as many as 66% of adults with dystonia meet criteria for a mental health problem over their lifetime (depression in 25-50%, anxiety in 34-60%). Due to the lack of control groups, and lack of variability in mental health problems explored, it is difficult to establish what the overall likelihood of having mental health difficulties is for adults with dystonia. This review aimed to examine whether adults with dystonia are more likely to have a mental health problem than adults without dystonia. A literature search was conducted in PubMed and PsycINFO using 'dystonia', 'mental health' and 'control group' search terms. In total, 553 papers were screened against inclusion criteria (i.e., adults with dystonia and a control group, and data specifying numbers of participants scoring above clinical cut-off on a valid and reliable measure of mental health) and exclusion criteria (i.e., no tardive dyskinesia, not clear dystonia, and exclusion of mental health problems), which resulted in 14 papers being reviewed. Studies were from a range of countries and site types, and included different types of dystonia. Sample sizes were 16-221 dystonia participants and 23-3943 control participants, and participant ages were 20-89 years. Studies used clinical interviews, self-report measures, or a combination of both. Quality assessment carried out using the Newcastle-Ottawa scale found that many studies were of poor quality due to the dystonia sample not being generalisable, no use of matching in case-control designs, and non-blinding of interviewers. The majority of studies found that people with dystonia (55-64%) were significantly more likely to have a mental health problem than controls (14-37%). There was more consistent evidence for depression, general anxiety and social anxiety among people with dystonia. Some mental health problems were more likely in people with dystonia but were only explored in a small number of studies (e.g., bipolar affective disorder, alcohol problems and bulimia nervosa). There were conflicting results for some mental health problems (e.g., dysthymia, generalised anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, phobias and psychosis). No evidence was found to suggest people with dystonia were more likely to have adjustment disorder or somatization. This review could access eligible journal articles in full, had no language bias, and used extensive search terms. However, the search was restricted to journal articles, and conducted using just two databases. Studies had different inclusion and exclusion criteria (e.g., use of antidepressants), and some had insufficient sample sizes to provide adequate statistical power or did not do statistical comparisons. This meant that it was not possible to discuss subtypes of dystonia separately. For some mental health problems, too few studies reported data that reliable conclusions could be drawn from. The results from this review are generalisable (due to the range of methodologies used, types of dystonia and countries), however there is limited consistency. More research is needed with control groups on a greater range of mental health difficulties. Nonetheless, it is important for clinicians to be aware of the signs for mental health difficulties people with dystonia may have. Screening measures for mental health problems among people with dystonia could be useful in clinical settings.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: dystonia ; mental health ; depression ; anxiety ; neuropsychology