Tuesday, March 23, 2021

Dystonia May Increase Risk of Suicide

Patients with dystonia—a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal movements and postures—may be at a higher risk of suicide compared with the general population, according to a recent report in Neurology.

“[I]n addition to debilitating motor symptoms, up to 90% of patients with dystonia have comorbid psychiatric disorders, most frequently including generalized or social anxiety, obsessive-compulsive disorder, and major depression,” wrote co-authors Alexis Worthley, B.A., and Kristina Simonyan, M.D., Ph.D., Dr. Med., of Harvard Medical School.

To examine the relationship between dystonia and suicidal behaviors, Worthley and Simonyan invited patients with dystonia to complete an online survey, which included questions about dystonia diagnosis and treatment as well as past and present psychiatric history. The participants were also specifically asked whether they had had thoughts of harming or killing themselves and whether they had ever made a suicide attempt.

A total of 542 participants (mean age: 57 years; 80% female), the majority of whom had been diagnosed with focal dystonia, completed the online survey. The most frequent psychiatric disorder reported by the participants was generalized anxiety (43.4%), followed by depression (40.4%), social anxiety (29.1%), and panic disorder (13.8%).

Overall, 32.3% of the participants reported a lifetime history of suicidal ideation—a percentage the authors noted is more than three times the prevalence rate of suicidal ideations in the general global population. The prevalence of suicidality was higher in patients with multifocal/segmental and generalized forms of dystonia compared with patients with focal dystonias, the authors noted.

Among the participants who reported a history of suicidal ideations, 16.6% reported having made a suicide attempt. Patients with generalized dystonia were found to have the highest incidence of a suicide attempt over their lifetime, with an ideation-to-attempt ratio of 4:1.

“[A]lthough it is necessary to consider depression and other psychiatric history as potential risk factors for suicidal ideations and attempt, it is also critical to evaluate their interplay with dystonia symptomatology, the individual’s propensity to suicide, and other potential social and biological stressors that may lead to suicidal behavior in patients with dystonia,” Worthley and Simonyan wrote.

“Given the devastating effects of suicide, our findings strongly support the incorporation of a suicidal risk screening into the routine clinical evaluations of patients with dystonia,” they added.

For related information, see the Psychiatric News article “Tardive Dyskinesia: Assessing and Treating a Debilitating Side Effect of Prolonged Antipsychotic Exposure.”

(Image: iStock/SeventyFour)

Resident-Fellow Members: Webinar With Task Force on Structural Racism is Tonight

Resident-fellow members are urged to register for the APA Presidential Task Force to Address Structural Racism Throughout Psychiatry for a discussion on the task force’s work and opportunities to get involved as the work continues. The event will be held tonight at 7 p.m. ET.


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