Journal of Neurology

, Volume 265, Issue 4, pp 970–975 | Cite as

Cervical dystonia and substance abuse

  • Abhimanyu Mahajan
  • Joseph Jankovic
  • Laura Marsh
  • Achint Patel
  • H. A. Jinnah
  • Cynthia Comella
  • Richard Barbano
  • Joel Perlmutter
  • Neepa Patel
  • For the members of the Dystonia Coalition
Short Commentary

Abstract

Objective

To investigate the prevalence of substance abuse (SA) in patients with cervical dystonia (CD) and to correlate it with prevalence of psychiatric disorders.

Methods

Data on anxiety, depression, dystonia severity, and substance abuse were collected from ten sites participating in the Dystonia Coalition. Patients were divided into two groups according to the presence of SA, utilizing Structured Clinical Interview for DSM-4 criteria. Wilcoxon Rank-Sum test was used to analyze the difference in median scores on the questionnaires between the groups. Chi-square test was used to analyze association between opiate and benzodiazepine use and SA. Association between TWSTRS severity and SA and medication use was assessed. A two-tailed p value of < 0.05 was considered significant. SAS 9.3 (SAS Institute Inc., Cary, NC, USA) was used for all analyses.

Results

Of 208 CD patients, 23 (11%) were identified with SA; 26.3% of patients with SA were on opiates compared to 7.2% of CD patients without SA (p = 0.006). Compared to non-SA patients, those experiencing SA were more likely male (88.9%; p = 0.0007), younger (median age 55; p = 0.031), and scored worse on questionnaires assessing depression (p = 0.044, p = 0.005), anxiety (p = 0.003), and dystonia psychiatric severity (p = 0.033). The median TWSTRS motor severity scores were higher in SA patients compared to non-SA patients (20 versus 16, p = 0.0339). The median TWSTRS total disability, motor, and pain scores were higher in patients on opiates than patients who were not (12 versus 8, p = 0.0071; 18.5 versus 16, p = 0.0243; 12.4 versus 6.7, p = 0.0052, respectively).

Conclusions

Potential risk factors for SA in CD patients include younger age and male gender with comorbid anxiety, depression and other psychiatric problems. Caution should be exercised when prescribing drugs with potential for abuse in these patients.

Keywords

Dystonia Neuroepidemiology Psychiatric disorders Alcohol Substance abuse 

Notes

Acknowledgements

We would like to acknowledge Ms. Lea Kiefer, the study coordinator at Baylor College of Medicine, who recognized the high incidence of substance abuse our patients.

Author contributions

AM: research project: organisation, execution; statistical analysis: design and execution; manuscript preparation: writing of the first draft. JJ: research project: conception; statistical analysis: review and critique; manuscript preparation: review and critique. LM: statistical analysis: review and critique; manuscript preparation: review and critique. AP: statistical analysis: design and execution. HAJ: statistical analysis: review and critique; manuscript preparation: review and critique. CC: statistical analysis: review and critique; manuscript preparation: review and critique. RB: statistical analysis: review and critique; manuscript preparation: review and critique. JP: statistical analysis: review and critique; manuscript preparation: review and critique. NP: research project: conception; statistical analysis: design, review and critique; manuscript preparation: review and critique.

Compliance with ethical standards

Conflicts of interest

Dr. Abhimanyu Mahajan has no conflicts of interest. Dr. Joseph Jankovic has no conflicts of interest. Dr. Achint Patel has no conflicts of interest. Dr. Laura Marsh has no conflicts of interest. Dr. H. A. Jinnah has active or recent grant support from the US government (National Institutes of Health), private philanthropic organisations (the Benign Essential Blepharospasm Research Foundation, Cure Dystonia Now), academically oriented institutions (the Dystonia Study Group), and industry (Cavion Therapeutics, Ipsen Pharmaceuticals, Retrophin Inc.). Dr. Jinnah has also served on advisory boards or as a consultant for Abide Therapeutics, Allergan Inc., Psyadon Pharmaceuticals, Retrophin Inc., Saol Therapeutics, and Medtronic Inc. He has received honoraria or stipends for lectures or administrative work from the American Academy of Neurology, the Dystonia Medical Research Foundation, the International Neurotoxin Society, the International Parkinson’s Disease and Movement Disorders Society, The Parkinson’s Disease Foundation, and Tyler’s Hope for a Cure. Dr. Jinnah serves on the Scientific Advisory Boards for Cure Dystonia Now, the Dystonia Medical Research Foundation, Lesch-Nyhan Action France, and Tyler’s Hope for a Cure. He also is principle investigator for the Dystonia Coalition, which receives the majority of its support through NIH grant TR001456 from the Office of Rare Diseases Research at the National Center for Advancing Translational Sciences, and previously NS065701 from the National Institutes of Neurological Disorders and Stroke. The Dystonia Coalition has received additional material or administrative support from industry sponsors (Allergan Inc. and Merz Pharmaceuticals) as well as private foundations (The American Dystonia Society, Beat Dystonia, The Benign Essential Blepharospasm Foundation, Cure Dystonia Now, Dystonia Inc., Dystonia Ireland, The Dystonia Medical Research Foundation, The European Dystonia Federation, The Foundation for Dystonia Research, The National Spasmodic Dysphonia Association, and The National Spasmodic Torticollis Association). Dr. Comella serves on the editorial board of Clinical Neuropharmacology, Sleep Medicine, and Continuum. She receives research support from the NIH R01NS074343, U54NS065701, Dystonia Medical Research Foundation, Merz Pharmaceutical, Revance Therapeutic, Retrophin, and Acorda Therapeutic. She receives compensation/honoraria for services as a consultant or an advisory committee member: Acorda Therapeutics, Allergan, Inc.; Lundbeck Ltd.; Medtronic Inc.; Merz Pharmaceuticals; Acadia Pharmaceuticals; Jazz Pharmaceuticals, Neurocrine Biosciences Inc., Revance Therapeutic. She receives royalties from Cambridge, Wolters Kluwer. She receives research support from the Parkinson’s Disease Foundation. Dr. Richard Barbano serves on a scientific advisory board and speaker’s bureau for Allergan; serves as an associate editor for Neurology: Clinical Practice, performs botulinum toxin injections at the University of Rochester (30% effort); receives research support from Allergan, Vaccinex, and Biotie; has received research support from NIH, NINDS, ORDR: Dystonia Coalition Projects, Site PI; holds stock/stock options in VisualDx; and has served as an expert witness in legal proceedings including malpractice, not involving commercial entities. Dr. Joel Perlmutter has support from NIH (NINDS, NIA), CHDI, APDA, Greater St. Louis Chapter of the APDA, MJ Fox Foundation, Barnes-Jewish Hospital Foundation. He has no conflicts of interest. Dr. Neepa Patel has received honoraria as a consultant for Acadia pharmaceuticals and as a speaker for Teva pharmaceuticals.

References

  1. 1.
    Albanese A, Bhatia K, Bressman SB et al (2013) Phenomenology and classification of dystonia: a consensus update. Mov Disord 28(7):863–873CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Comella C, Bhatia K (2015) An international survey of patients with cervical dystonia. J Neurol 262(4):837–848CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Tomic S, Petkovic I, Pucic T, Resan B, Juric S, Rotim T (2016) Cervical dystonia and quality of life. Acta Neurol Belg 116(4):589–592CrossRefPubMedGoogle Scholar
  4. 4.
    Gundel H, Wolf A, Xidara V, Busch R, Ceballos-Baumann AO (2001) Social phobia in spasmodic torticollis. J Neurol Neurosurg Psychiatry 71(4):499–504CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Berardelli I, Ferrazzano G, Pasquini M, Biondi M, Berardelli A, Fabbrini G (2015) Clinical course of psychiatric disorders in patients with cervical dystonia. Psychiatry Res 229(1–2):583–585CrossRefPubMedGoogle Scholar
  6. 6.
    Fabbrini G, Berardelli I, Moretti G et al (2010) Psychiatric disorders in adult-onset focal dystonia: a case-control study. Mov Disord 25(4):459–465CrossRefPubMedGoogle Scholar
  7. 7.
    Zurowski M, McDonald WM, Fox S, Marsh L (2013) Psychiatric comorbidities in dystonia: emerging concepts. Mov Disord 28(7):914–920CrossRefPubMedGoogle Scholar
  8. 8.
    Thenganatt MA, Jankovic J (2014) Treatment of dystonia. Neurotherapeutics 11(1):139–152CrossRefPubMedGoogle Scholar
  9. 9.
    Kalapatapu RK, Sullivan MA (2010) Prescription use disorders in older adults. Am J Addict 19(6):515–522CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Pirio Richardson S, Wegele AR, Skipper B, Deligtisch A, Jinnah HA (2017) Dystonia treatment: patterns of medication use in an international cohort. Neurology 88(6):543–550CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hasin DS, O’Brien CP, Auriacombe M et al (2013) DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry 170(8):834–851CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kuerbis A, Sacco P, Blazer DG, Moore AA (2014) Substance abuse among older adults. Clin Geriatr Med 30(3):629–654CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Swendsen J, Conway KP, Degenhardt L et al (2010) Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction 105(6):1117–1128CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Compton WM, Thomas YF, Stinson FS, Grant BF (2007) Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry 64(5):566–576CrossRefPubMedGoogle Scholar
  15. 15.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602CrossRefPubMedGoogle Scholar
  16. 16.
    Quello SB, Brady KT, Sonne SC (2005) Mood disorders and substance use disorder: a complex comorbidity. Sci Pract Perspect 3(1):13–21CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Regier DA, Farmer ME, Rae DS et al (1990) Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 264(19):2511–2518CrossRefPubMedGoogle Scholar
  18. 18.
    Bruce SE, Yonkers KA, Otto MW et al (2005) Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 162(6):1179–1187CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kyllerman M, Forsgren L, Sanner G, Holmgren G, Wahlstrom J, Drugge U (1990) Alcohol-responsive myoclonic dystonia in a large family: dominant inheritance and phenotypic variation. Mov Disord 5(4):270–279CrossRefPubMedGoogle Scholar
  20. 20.
    Berman BD, Junker J, Shelton E et al (2017) Psychiatric associations of adult-onset focal dystonia phenotypes. J Neurol Neurosurg Psychiatry 88(7):595–602.  https://doi.org/10.1136/jnnp-2016-315461 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hall AJ, Logan JE, Toblin RL et al (2008) Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 300(22):2613–2620CrossRefPubMedGoogle Scholar
  22. 22.
    Edlund MJ, Sullivan M, Steffick D, Harris KM, Wells KB (2007) Do users of regularly prescribed opioids have higher rates of substance use problems than nonusers? Pain Med 8(8):647–656CrossRefPubMedGoogle Scholar
  23. 23.
    Forman RF, Svikis D, Montoya ID, Blaine J (2004) Selection of a substance use disorder diagnostic instrument by the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 27(1):1–8CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    van den Dool J, Tijssen MA, Koelman JH, Engelbert RH, Visser B (2016) Determinants of disability in cervical dystonia. Parkinsonism Relat Disord 32:48–53CrossRefPubMedGoogle Scholar
  25. 25.
    Landsman-Blumberg PB, Katz N, Gajria K, Coutinho AD, Yeung PP, White R (2017) Burden of alcohol abuse or dependence among long-term opioid users with chronic noncancer pain. J Manag Care Spec Pharm 23(7):718–724CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Abhimanyu Mahajan
    • 1
  • Joseph Jankovic
    • 2
  • Laura Marsh
    • 3
  • Achint Patel
    • 4
  • H. A. Jinnah
    • 5
  • Cynthia Comella
    • 6
  • Richard Barbano
    • 7
  • Joel Perlmutter
    • 8
  • Neepa Patel
    • 1
  • For the members of the Dystonia Coalition
  1. 1.Department of Neurology, Henry Ford Health SystemHenry Ford HospitalDetroitUSA
  2. 2.Department of NeurologyBaylor College of MedicineHoustonUSA
  3. 3.Department of Psychiatry and NeurologyBaylor College of MedicineHoustonUSA
  4. 4.Department of NeurologyUniversity of Arkansas Medical CenterLittle RockUSA
  5. 5.Department of Neurology and Human GeneticsEmory UniversityAtlantaUSA
  6. 6.Department of NeurologyRush UniversityChicagoUSA
  7. 7.Department of NeurologyUniversity of RochesterRochesterUSA
  8. 8.Department of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational TherapyWashington University at St. LouisSt. LouisUSA

Personalised recommendations