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Dystonia – a Potential Psychiatric Pitfall

Published online by Cambridge University Press:  02 January 2018

D. G. Cunningham Owens*
Affiliation:
Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA1 3UJ

Abstract

The manifold presentations of dystonia have been acknowledged as a spectrum of illness. Dystonia is primarily idiopathic or drug-induced; purely psychogenic causes would seem to be rare, although such an aetiology is commonly assumed. Response to medication in idiopathic cases is unpredictable, although anticholinergic medication and behavioural programmes are being evaluated.

Type
Review Article
Copyright
Copyright © Royal College of Psychiatrists, 1990 

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References

Abse, D. W. (1966) Hysteria and Related Mental Disorders. Bristol: John Wright.Google Scholar
Addonizio, G. & Alexopoulos, G. S. (1988) Drug-induced dystonia in young and elderly patients. American Journal of Psychiatry, 145, 869871.Google ScholarPubMed
American Psychiatric Association Task Force on Late Neurological Effects of Antipsychotic Drugs (1979) Tardive Dyskinesia. Washington, DC: APA.Google Scholar
Ayd, F. (1961) A survey of drug-induced extrapyramidal reactions. Journal of the American Medical Association, 175, 10541060.CrossRefGoogle ScholarPubMed
Ayd, F. (1983) Early-onset neuroleptic-induced extrapyramidal reactions: a second survey, 1961–1981. In Neuroleptics: Neurochemical, Behavioural and Clinical Perspectives (eds Coyle, J. T. & Enna, S. J.). New York: Raven Press.Google Scholar
Batshaw, M. L., Wachtel, R. C., Deckel, A. W., et al (1985) Munchausen's syndrome simulating torsion dystonia. New England Journal of Medicine, 312, 14371439.CrossRefGoogle ScholarPubMed
Burke, R. E., Fahn, S., Jankovic, J., et al (1982) Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology, 32, 13351346.CrossRefGoogle ScholarPubMed
Burke, R. E., Fahn, S. & Marsden, C. D. (1986) Torsion dystonia: a double-blind, prospective trial of high-dosge trihexyphenidyl. Neurology, 36, 160164.CrossRefGoogle ScholarPubMed
Burke, R. E. & Kang, U. J. (1988) Tardive dystonia: clinical aspects and treatment. Advances in Neurology, 49, 199210.Google Scholar
Chadwick, D., Reynolds, E. H. & Marsden, C. D. (1976) Anticonvulsant-induced dyskinesias: a comparison with dyskinesias induced by neuroleptics. Journal of Neurology, Neurosurgery and Psychiatry, 39, 12101218.CrossRefGoogle ScholarPubMed
Cockburn, J. J. (1971) Spasmodic torticollis: a psychogenic condition? Journal of Psychosomatic Research, 15, 471477.CrossRefGoogle ScholarPubMed
Cooper, I. S., Cullinan, T. & Riklan, M. (1976) The natural history of dystonia. Advances in Neurology, 14, 157169.Google ScholarPubMed
Crisp, A. H. & Moldofsky, H. (1965) A psychosomatic study of writers' cramp. British Journal of Psychiatry, 111, 841858.CrossRefGoogle Scholar
Crosley, C. J. & Swender, P. T. (1979) Dystonia associated with carbamazepine administration: experience in brain-damaged children. Paediatrics, 63, 612615.CrossRefGoogle ScholarPubMed
Crow, T. J., MacMillan, J. F., Johnson, A. L., et al (1986) The Northwick Park Study of First Episodes of Schizophrenia. II A randomised controlled trial of prophylactic neuroleptic treatment. British Journal of Psychiatry, 148, 120127.CrossRefGoogle Scholar
Curtis, L., Lees, A. J., Stern, G. M., et al (1984) Effect of L-dopa on course of Parkinson's disease. Lancet, ii, 211212.CrossRefGoogle Scholar
Denny-Brown, D. (1962) The Basal Ganglia and their Relation to Disorders of Movement. London: Oxford University Press.Google Scholar
Duane, D. (1988) Spasmodic torticollis. Advances in Neurology, 49, 135150.Google ScholarPubMed
Ekbom, K., Lindholm, H. & Ljungberg, L. (1972) New dystonic syndrome associated with butyrophenone therapy. Journal of Neurology, 202, 94103.CrossRefGoogle ScholarPubMed
Eldridge, R., Riklan, M. & Cooper, I. S. (1969) The limited role of psychotherapy in torsion dystonia. Journal of the American Medical Association, 210, 705708.CrossRefGoogle ScholarPubMed
Fahn, S. (1983) High dosage anticholinergic therapy in dystonia. Neurology, 33, 12551261.CrossRefGoogle ScholarPubMed
Fahn, S. (1984) The varied clinical expressions of dystonia. Neurologic Clinics, 2, 541554.CrossRefGoogle ScholarPubMed
Fahn, S. (1986) Generalised dystonia: concepts and treatment. Clinical Neuropharmacology, 9 (suppl. 2), S37S48.CrossRefGoogle Scholar
Fahn, S., Williams, D., Reches, A., et al (1983) Hysterical dystonia, a rare disorder: report of five documented cases. Neurology, 33 (suppl. 2), 161.Google Scholar
Fahn, S. & Marsden, C. D. (1987) The treatment of dystonia. In Movement Disorders, 2 (eds Marsden, C. D. & Fahn, S.). London: Butterworths.Google Scholar
Fahn, S., Marsden, C. D. & Calne, D. B. (1987) Classification and investigation of dystonia. In Movement Disorders, 2 (eds Marsden, C. D. & Fahn, S.). London: Butterworths.Google Scholar
Faulstich, M. E., Carnrike, C. L. M. & Williamson, D. A. (1985) Blepharospasm and Meige syndrome: a review of diagnostic, aetiological and treatment approaches. Journal of Psychosomatic Research, 29, 8994.CrossRefGoogle ScholarPubMed
Ferguson, D. (1971) An Australian study of telegraphists' cramp. British Journal of Industrial Medicine, 28, 280285.Google ScholarPubMed
Flatau, E. & Sterling, W. (1911) Progressiver torsionspasms bei kindern. Zeitschrift Gesamte Fur Neurologie und Psychiatric, 7, 586612.CrossRefGoogle Scholar
Gerlach, J. (1979) Tardive Dyskinesia. Copenhagen: Laege-foreningens Forlag.Google ScholarPubMed
Gilbert, G. J. (1977) Familial spasmodic torticollis. Neurology, 27, 1113.CrossRefGoogle ScholarPubMed
Gimenez-Roldan, S., Mateo, D. & Bartolome, P. (1985) Tardive dystonia and severe tardive dyskinesia. Acta Psychiatrica Scandinavica, 71, 488494.CrossRefGoogle ScholarPubMed
Goldstein, J. E. & Cogan, D. G. (1965) Apraxia of lid opening. Archives of Ophthalmology, 73, 155159.CrossRefGoogle ScholarPubMed
Gowers, W. R. (1888) A Manual of Diseases of the Nervous System. London: Churchill.CrossRefGoogle Scholar
Hammond, W. A. (1871) A Treatise on Diseases of the Nervous System. New York: Appleton-Century-Crofts.Google Scholar
Hochberg, F. H., Leffert, R. D., Heller, M. D., et al (1983) Hand difficulties among musicians. Journal of the American Medical Association, 249, 18691872.CrossRefGoogle ScholarPubMed
Hunter, D. (1978) The Diseases of Occupations. London: Hodder and Stoughton.Google Scholar
Jacome, D. (1979) Carbamazepine-induced dystonia. Journal of the American Medical Association, TAX, 2263.Google Scholar
Jankovic, J. (1981) Drug-induced and other orofacial cervical dyskinesias. Annals of Internal Medicine, 94, 788793.CrossRefGoogle ScholarPubMed
Jankovic, J. (1988a) Cranial-cervical dyskinesias: an overview. Advances in Neurology, 49, 113.Google ScholarPubMed
Jankovic, J. (1988b) Etiology and differential diagnosis of blepharospasm and oromandibular dystonia. Advances in Neurology, 49, 103116.Google ScholarPubMed
Jankovic, J. (1988c) Botulinum A toxin in the treatment of blepharospasm. Advances in Neurology, 49, 467472.Google ScholarPubMed
Jankovic, J., Havins, W. E. & Wilkins, R. B. (1982) Blinking and blepharospasm: mechanism, diagnosis and management. Journal of the American Medical Association, 248, 31603164.CrossRefGoogle ScholarPubMed
Jankovic, J. & Ford, J. (1983) Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Annals of Neurology, 13, 402411.CrossRefGoogle ScholarPubMed
Jelliffe, S. E. (1929) Psychological components in postencephalitic oculogyric crises. Archives of Neurology and Psychiatry, 21, 491532.CrossRefGoogle Scholar
Jellinek, T. (1977) Mood elevating effect of trihexyphenidyl and biperiden in individuals taking antipsychotic medication. Diseases of the Nervous System, 38, 353355.Google ScholarPubMed
Jeste, D. V. & Wyatt, R. J. (1981) Dogma disputed: is tardive dyskinesia due to postsynaptic dopamine receptor supersensitivity? Journal of Clinical Psychiatry, 42, 455457.Google ScholarPubMed
Jeste, D. V. & Wyatt, R. J. (1982) Understanding and Treating Tardive Dyskinesia. New York: The Guilford Press.Google Scholar
Johnson, D. A. W. (1973) The side-effects of fluphenazine decanoate. British Journal of Psychiatry, 123, 519522.CrossRefGoogle ScholarPubMed
Kaminer, Y., Munitz, H. & Wijsenbeek, H. (1982) Trihexyphenidyl (Artane) abuse: euphoriant and anxiolytic. British Journal of Psychiatry, 140, 473474.CrossRefGoogle ScholarPubMed
Kang, U. J., Burke, R. E. & Fahn, S. (1986) Natural history and treatment of tardive dystonia. Movement Disorders, 1, 193208.CrossRefGoogle ScholarPubMed
Keegan, D. L. & Rajput, A. H. (1973) Drug-induced dystonia tarda: treatment with L-dopa. Diseases of the Nervous System, 38, 167169.Google Scholar
Lancet (1985) Editorial: The management of dystonias. Lancet, i, 321322.Google Scholar
Lazarus, A. L. & Toglia, J. U. (1985) Fatal myoglobinuric renal failure in a patient with tardive dyskinesia. Neurology, 35, 10551057.CrossRefGoogle Scholar
Lee, L. V., Pascasio, F. M., Fuentes, F. D., et al (1976) Torsion dystonia in Panay, Philippines. Advances in Neurology, 14, 137151.Google ScholarPubMed
Lees, A. J. (1985) Tics and Related Disorders. Edinburgh: Churchill-Livingstone.Google Scholar
Lepore, F. E. & Duvoisin, R. C. (1985) ‘Apraxia’ of eyelid opening: an involuntary levator inhibition. Neurology, 35, 423427.CrossRefGoogle ScholarPubMed
Lesser, R. P. & Fahn, S. (1978) Dystonia: a disorder often misdiagnosed as a conversion reaction. American Journal of Psychiatry, 135, 349352.Google ScholarPubMed
Liversedge, L. A. (1961) Writers' cramp and the conditioned reflex. In Scientific Aspects of Neurology (ed. Garland, H.). London: Livingstone.Google Scholar
MacMillan, J. F. Crow, T. J., Johnson, A. L., et al (1986) The Northwick Park Study of First Episodes of Schizophrenia. III: Short-term outcome in trial entrants and trial eligible patients. British Journal of Psychiatry, 148, 128133.CrossRefGoogle Scholar
Marsden, C. D. (1976a) Dystonia: the spectrum of the disease. In The Basal Ganglia (ed. Yahr, M. D.). New York: Raven Press.Google Scholar
Marsden, C. D. (1916b) Blepharospasm-oromandibular dystonia syndrome (Brueghel's syndrome). Journal of Neurology, Neurosurgery and Psychiatry, 39, 12041209.CrossRefGoogle Scholar
Marsden, C. D. (1986) The focal dystonias. Clinical Neuropharmacology, 9 (suppl. 2), S49S60.CrossRefGoogle ScholarPubMed
Marsden, C. D., Tarsy, D. & Baldessarini, R. J. (1975) Spontaneous and drug-induced movement disorders in psychotic patients. In Psychiatric Aspects of Neurological Disease (eds Benson, D. F. & Blumer, D.). New York: Grune and Stratton.Google Scholar
Marsden, C. D., Harrison, M. J. G. & Bundey, S. (1976) Natural history of idiopathic torsion dystonia. Advances in Neurology, 14, 177187.Google ScholarPubMed
Marsden, C. D. & Jenner, P. (1980) The pathophysiology of extrapyramidal side-effects of neuroleptic drugs. Psychological Medicine, 10, 5572.CrossRefGoogle ScholarPubMed
Marsden, C. D. & Sheehy, M. P. (1982) Spastic dysphonia, Meige's disease and torsion dystonia. Neurology, 32, 12021203.CrossRefGoogle ScholarPubMed
Marsden, C. D., Marion, M. H. & Quinn, N. (1984) The treatment of severe dystonia in children and adults. Journal of Neurology, Neurosurgery and Psychiatry, 47, 11661173.CrossRefGoogle ScholarPubMed
Marsden, C. D., Obeso, J. A., Zarranz, J. J., et al (1985) The anatomical basis of symptomatic dystonia. Brain, 108, 463483.CrossRefGoogle Scholar
Mattson, R. H. & Calverley, J. R. (1968) Dextroamphetamine-sulphate-induced dyskinesias. Journal of the American Medical Association, 204, 400402.CrossRefGoogle ScholarPubMed
Meige, H. (1910) Les convulsions de la face, une forme clinique de convulsion faciale bilateral et mediane. Revue Neurologique, 21, 437443.Google Scholar
Melvin, K. E. W. (1962) Tetanus-like reactions to the phenothiazine drugs: ‘the grimacing syndrome’. New Zealand Medical Journal, 61, 9092.Google Scholar
Myslobodsky, M. S., Holden, T. & Sandler, R. (1984) Asymmetry of abnormal involuntary movements: a prevalence study. Biological Psychiatry, 19, 623628.Google ScholarPubMed
Nausieda, P. A., Weiner, W. J. & Klawans, H. L. (1980) Dystonic foot response of Parkinsonism. Archives of Neurology, 37, 132136.CrossRefGoogle ScholarPubMed
Obeso, J. A., Rothwell, J. C., Lang, A. E., et al (1983) Myoclonic dystonia. Neurology, 33, 825830.CrossRefGoogle ScholarPubMed
Oppenheim, H. (1911) Uber eine eigenartige krampfkrankheit des kindlichen und jugendlichen alters (dysbasia lordotica progressiva, dystonia musculorum deformans). Neurologie Centralblatt, 30, 10901107.Google Scholar
Owens, D. G. C. (1985) The disabilities of chronic schizophrenia: a search for neurological correlates. MD Thesis, University of Glasgow.Google Scholar
Owens, D. G. C., Johnstone, E. C. & Frith, C. D. (1982) Spontaneous involuntary disorders of movement: their prevalence, severity and distribution in chronic schizophrenics with and without treatment with neuroleptics. Archives of General Psychiatry, 39, 452461.CrossRefGoogle ScholarPubMed
Pai, M. N. (1947) The nature and treatment of ‘writer's cramp’. Journal of Mental Science, 93, 6881.CrossRefGoogle ScholarPubMed
Paulson, G. W. (1972) Meige's syndrome: dyskinesias of the eyelids and facial muscles. Geriatrics, 27, 6973.Google ScholarPubMed
Poewe, W. H., Lees, A. J. & Stern, G. M. (1988) Dystonia in Parkinson's disease: clinical and pharmacological features. Annals of Neurology, 23, 7378.CrossRefGoogle ScholarPubMed
Powers, J. M. (1982) Decongestant-induced blepharospasm and orofacial dystonia. Journal of the American Medical Association, 247, 32443245.CrossRefGoogle ScholarPubMed
Purves Stewart, J. (1898) Paralysis agitans: with an account of a new symptom. Lancet, ii, 12581260.CrossRefGoogle Scholar
Rogers, D. & Hymas, N. (1988) Sporadic facial stereotypies in patients with schizophrenia and compulsive disorders. Advances in Neurology, 49, 383394.Google ScholarPubMed
Rosenbaum, F. & Jankovic, J. (1988) Focal task-specific tremor and dystonia: categorisation of occupational movement disorders. Neurology, 38, 522527.CrossRefGoogle ScholarPubMed
Schwalbe, W. (1908) Eine Eigentumliche tonische Krampfform mit Hysterischen Symptomen. Inaugural dissertation. Berlin: G. Shade.Google Scholar
Shader, R. I. & Greenblatt, D. J. (1971) Uses and toxicity of belladona alkaloids and synthetic anticholinergics. Seminars in Psychiatry, 3, 449476.Google Scholar
Sheehy, M. P. & Marsden, C. D. (1980) Trauma and pain in spasmodic torticollis. Lancet, i, 777778.CrossRefGoogle Scholar
Sheehy, M. P. & Marsden, C. D. (1982) Writers' cramp – a focal dystonia. Brain, 105, 461480.CrossRefGoogle ScholarPubMed
Stahl, S. M., Yesavage, J. A. & Berger, P. A. (1982) Pharmacologic characteristics of Meige's dystonia: differentiation from tardive dyskinesia. Journal of Clinical Psychiatry, 43, 445446.Google ScholarPubMed
Swett, C. (1975) Drug-induced dystonias. American Journal of Psychiatry, 132, 532534.Google Scholar
Tibbetts, R. W. (1971) Spasmodic torticollis. Journal of Psychosomatic Research, 15, 461469.CrossRefGoogle ScholarPubMed
Tolosa, E. S. (1981) Clinical features of Meige's disease (idiopathic orofacial dystonia). Archives of Neurology, 38, 147151.CrossRefGoogle ScholarPubMed
Tolosa, E. & Klawans, H. L. (1979) Meige's disease: a clinical form of facial convulsion bilateral and medial. Archives of Neurology, 36, 635637.CrossRefGoogle ScholarPubMed
Tolosa, E. & Marti, M. J. (1988) Blepharospasm-oromandibular dystonia syndrome (Meige's syndrome): clinical aspects. Advances in Neurology, 49, 7384.Google ScholarPubMed
Van Bogaert, (1934) Ocular paroxysms and palilalia. Journal of Nervous and Mental Diseases, 80, 4861.CrossRefGoogle Scholar
Waziri, R. (1980) Lateralisation of neuroleptic induced dyskinesia indicates pharmacologic asymmetry in the brain. Psychopharmacology, 68, 5153.CrossRefGoogle ScholarPubMed
Wechsler, I. S. & Brock, S. (1922) Dystonia musculorum deformans with especial reference to a myostatic form and the occurrence of decerebrate rigidity phenomena: a study of six cases. Archives of Neurology and Psychiatry, 8, 538552.CrossRefGoogle Scholar
Weiden, P. J., Mann, J. J., Haas, G., et al (1987) Clinical non-recognition of neuroleptic-induced movement disorders: a cautionary study. American Journal of Psychiatry, 144, 11481153.Google Scholar
Weiner, W. J., Nausieda, P. A. & Glanz, R. H. (1981) Meige syndrome (blepharospasm-oromandibular dystonia) after long-term neuroleptic therapy. Neurology, 31, 15551556.CrossRefGoogle ScholarPubMed
Weiner, W. J. & Nausieda, P. A. (1982) Meige's syndrome during long-term dopaminergic therapy in Parkinson's disease. Archives of Neurology, 39, 451452.CrossRefGoogle ScholarPubMed
Wilson, R. L., Waziri, R., Nasrallah, H. A., et al (1984) The lateralisation of tardive dyskinesia. Biological Psychiatry, 19, 629635.Google ScholarPubMed
Wilson, S. A. K. (1940) Neurology (ed. Bruce, A. N.). London: Edward Arnold.Google Scholar
Wohlfart, G., Ingvar, D. H. & Hellberg, A. M. (1961) Compulsory shouting (Benedek's ‘Klazomania’) associated with oculogyric spasms in chronic epidemic encephalitis. Acta Psychiatrica Scandinavica, 36, 369377.CrossRefGoogle ScholarPubMed
Yassa, R., Nair, V. & Dimitry, R. (1986) Prevalence of tardive dystonia. Acta Psychiatrica Scandinavica, 73, 629633.CrossRefGoogle ScholarPubMed
Zeman, W. & Dyken, P. (1968) Dystonia musculorum deformans. In Handbook of Neurology, Vol. 6 (ed. Vinken, P. J. & Bruyn, G. W.). Amsterdam: North Holland.Google Scholar
Ziehen, T. (1911) Ein fall von tonischer torsionsneurose. Neurologie Centralblatt, 30, 109110.Google Scholar
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