Prevalence of Suicidality in Focal and Generalized Dystonia: A Critical and Unrecognized Problem.

Several studies have emphasized the importance of neuropsychiatric abnormalities in idiopathic dystonia.1,2 Anxiety, depression, and obsessive-compulsive disorders are the most common ones. Psychiatric disorders may begin 18.4 ± 13.9 years before the onset of motor symptoms, and in 1 focal dystonia study, they were present in 57.3% of patients.3 The reported prevalence, however, may vary according to the type of focal dystonia. With cervical dystonia, 25.3% to 83.6% of patients will have a psychiatric disorder at some point in their lives; in blepharospasm, 67.7% to 71%; and in spasmodic dysphonia, between 37% and 42%.2 Most studies reveal no correlation between the severity of dystonia and a psychiatric disorder, raising the possibility that the high prevalence of lifetime psychiatric comorbidity might be a primary rather than a secondary phenomenon in focal dystonia.1,4 In addition, results of some generalized dystonia studies suggest that major depressive disorders may not arise primarily from motor disability but rather are linked to the DYT1 dystonia mutation.5 Neuropsychiatric disorders in dystonia significantly affect quality of life, which correlates with depression and anxiety.1,2 Although the prevalence of neuropsychiatric disorders in dystonia is greater than in age- and sex-matched controls, the risk and the incidence of suicidal behavior among patients with dystonia have not been investigated.