In a survey, 32.3% of patients with dystonia reported a lifetime history of suicidal ideation, which is a significantly higher rate of suicidal ideation than the 9.2% rate in the general population general, according to the results of the study published in Neurology.
Stigma surrounds suicidality and studies have indicated that up to 90% of patients with movement disorders have comorbid psychiatric disorders, including anxiety and major depression. As a result, study researchers hypothesized that patients’ suicidal behavior might not be disclosed during routine neurological assessments.
They recruited patients to complete a confidential 97-question online survey based on a previously used questionnaire and the Columbia Suicide Severity Rating Scale (C-SSRS). They also obtained general demographic data, clinical history and psychiatric history.
The final cohort included 542 participants (mean age, 57.4 ± 13.3 years; 80.8% female). Study researchers analyzed prevalence rates for the overall cohort and by form of dystonia. The group included 424 patients with focal dystonia (322 laryngeal dystonia, 57 cervical, 29 focal hand, 11 craniofacial, 4 lower limb, 1 abdominal/truncal), 63 multifocal/segmental dystonia, 54 generalized and 1 with hemidystonia.
In the cohort, 32.3% of patients reported a lifetime history of suicidal ideation (Fisher’s exact test: odds ratio (OD), 9.8; 95% CI, 6.4-15 ,4; corrected P =2.2e-16). Patients with generalized dystonia reported the highest incidence (50%) of suicidal ideation (OD, 9.7; 95% CI, 3.2-36.3; corrected P =4.7e-06), 46.0% follow-up in patients with multifocal/segmental dystonias (OD, 8.0; 95% CI, 2.9-25.9; corrected P =6.9e-06), 33.3% in patients with focal dystonias, including cervical, focal hand, craniofacial, lower extremity, abdominal/trunk forms (OD, 5.1; 95% CI %, 2.2-13.0, corrected P =2.5e-05), and 26.1% in patients with laryngeal dystonia (OD, 3.4; 95% CI, 2.2-5.6; corrected P =2.7e-08).
About 1 in 4 patients reported that their history of suicidal ideation was related to dystonia. The largest ratio, 1:2 dystonia-induced vs. non-dystonia-induced suicidality, was related to generalized and focal dystonias (excluding laryngeal dystonia). Of the patients with generalized dystonia, 16.7% reported the presence of suicidal ideation at the time of the study.
About 17% of patients reported having attempted suicide, with the highest incidence in patients with generalized dystonia (4:1 ratio of thoughts to attempts).
Patients most commonly reported the following psychiatric disorders: generalized anxiety (43.4%), depression (40.4%), and social anxiety (29.1%). Suicidal ideation was significantly associated with these psychiatric disorders (all P ≤.0004). Depression was associated with all forms of focal dystonia (all P ≤1.4e-05). Social anxiety was significantly related to suicidal behavior in the entire group of patients with dystonia (P =.0004).
Limitations of the study included possible self-report bias and sample size variation.
“Relatively low risk” patients with focal dystonia reported more significant associations between suicidal behavior and psychiatric disorders compared to “higher risk” patients with multifocal/segmental and generalized dystonias.
Therefore, in addition to considering psychiatric history, it is crucial to assess the interaction with dystonia symptoms, the individual’s propensity for suicide and other stressors, the researchers said. ‘study. They concluded that “suicidality in dystonia may be a critical, though unrecognized, feature of isolated dystonia. Screening for suicide risk should be integrated as part of a clinical assessment of patients with dystonia to prevent suicide-induced injury and death.
Worthley A, Simonyan K. Suicidal ideation and attempts in patients with isolated dystonia. Neurol. Published online January 27, 2021. doi:10.1212/WNL.0000000000011596