Psychiatric disorders in patients with blepharospasm — a reactive pattern?

https://doi.org/10.1016/S0022-3999(99)00105-1Get rights and content

Abstract

Objective: The purpose of this study was to assess the life-time prevalence of all major psychiatric disorders in patients suffering from blepharospasm.Method: A total of 31 consecutive patients with blepharospasm attending the Department of Neurology were interviewed at the Department of Psychiatry at the University of Vienna. Patients had been submitted to standard neurological diagnostic procedures, psychiatric diagnoses were made with the help of the SCID, functional impairment was assessed by the General Assessment of Functioning Scale (GAF).Results: A current or life-time psychiatric diagnosis was made for 22 patients (71%). The most frequent disorders were depressive disorders, mainly major depression (five patients, 16.1%), secondary dysthymia (six patients, 19.3%), and recurrent major depression (five patients, 16.1%). A diagnosis of simple phobia was made for seven patients (22.5%), for obsessive–compulsive disorder in three patients (9.6%). The mean GAF score of our sample was 63.1%.Conclusion: In contrast to previously published results, we did not find a high rate of a single specific disorder or patterns in our study sample, though by the inclusion of life-time diagnostic criteria, the majority of patients fulfilled criteria for at least one diagnosis. This might indicate the considerable negative impact of blepharospasm on the patients' lives.

Introduction

Blepharospasm is now considered to be a focal dystonia [1] and botulinumtoxin is the neurological treatment of choice for this disorder [2], [3], [5]. However, many authors claim at least a phenomenological link to different psychiatric disorders. For example, Cavenar et al. [2] described patients suffering from blepharospasm as seriously disturbed, close to psychosis, the dystonia “reflecting primitive defence mechanism” more than “simple conversion.” Bihari et al. [3] found an elevated score in the Maudsley OCD questionnaire in 21 patients suffering from blepharospasm. Scheidt et al. [4] could not reproduce these findings, but found no difference in the subscales of the SCL90 as compared to a control group. Using the Hamburg Obsession/Compulsion Inventory, Brooks et al. [5] found significantly more obsessive–compulsive symptoms in patients suffering from blepharospasm than in patients suffering from hemifacial spasm.

In a recent study, we found a high prevalence of anxiety disorders as well as of depression preceding the onset of another focal dystonia, spasmodic torticollis [6]. We used the Stuctured Clinical Diagnostic Interview for DSM-III-R (SCID, [7]), which, in contrast to self-rating scales, permits a more comprehensive diagnostic approach, and also retrospective diagnoses of all major psychiatric disorders.

We have now used the same methods in a group of patients suffering from blepharospasm, the aim of the study was to evaluate not only the core symptoms in individual scales, but the life-time presence or absence of all major psychiatric disorders, including obsessive–compulsive disorders. We also observed the impairment caused by blepharospasm, co-morbidity, and time of onset of psychiatric and neurological symptoms.

Section snippets

Method

A total of 31 consecutive patients with blepharospasm attending the out-patient department for neurology were included in this study and had agreed to go through the evaluation process. Patients had been submitted to standard neurological diagnostic procedures, including a clinical status taken by a senior neurologist as well as a CAT scan or a MRI of the brain. The complete SCID was taken with all patients, including life-time and present modules and the included axis V general assessment of

Results

The group consisted of 25 female and six male patients (mean age: 64.7 years, SD: ±9.4, range: 46 to 78). Time from onset of blepharospasm to evaluation ranged from 7 months to 16 years (mean: 80.4 months, SD: ±55.5, range: 7–204 months).

A current or life-time psychiatric diagnosis was made for 22 patients (71%). The most frequent disorders were depressive disorders, mainly major depression in five patients, secondary dysthymia in six patients, recurrent depression in five patients and simple

Discussion

The results of this study do not confirm the earlier findings of a high rate of obsessive–compulsive disorder or other marked characteristic serious psychopathology in all patients suffering from blepharospasm [3]. Disorders, apart from those that could be seen as being secondary or reactive to blepharospasm, were not more frequent than might have been expected in any clinical population [8].

The mean GAF score of 63.1% was lower than the score of 74.7% in the spasmodic torticollis group we

References (7)

  • JS Elston

    The clinical use of botulinum toxin

    Semin Ophthalmol

    (1988)
  • JO Cavenar et al.

    Blepharospasm: organic or functional?

    Psychosomatics

    (1987)
  • K Bihari et al.

    Blepharospasm and obsessive–compulsive disorder

    J Nerv Ment Dis

    (1992)
There are more references available in the full text version of this article.

Cited by (33)

  • Posttraumatic growth but not abnormal personality structure are typical for patients with essential blepharospasm

    2016, Basal Ganglia
    Citation Excerpt :

    EB may have a substantial impact on personality and mood [15,16]. Recent research has analyzed mainly negative effects: patients with FD had a higher rate of psychiatric comorbidities such as depression or obsessive-compulsive symptoms [17–20]. However, up to the present, there is not a single study of possible positive effects, especially of post-traumatic growth (PTG) in patients with EB.

  • Effects of botulinum toxin type a on quality of life assessed with the WHOQOL-BREF in hemifacial spasm and blepharospasm

    2013, Neurology Psychiatry and Brain Research
    Citation Excerpt :

    Social isolation due to the severe disfigurement and functional visual disturbances might have an impact on the social domain in BSP patients. Previous studies demonstrated that patients with BSP and HFS experience a multitude of physical and emotional symptoms.28,35,38–40 Although Hall et al. reported that patients with BSP were more depressive and anxious than patients with HFS, we did not found significantly difference among depression and anxiety scores between two patient groups.32

  • Obsessive-compulsive symptoms among patients with blepharospasm and hemifacial spasm

    2011, General Hospital Psychiatry
    Citation Excerpt :

    The fact that checking symptoms were found early in the course of BSP could be interpreted in at least two different ways. Firstly, checking symptoms could represent an early psychological reaction to the impairment (e.g., functional blindness) resulting from BSP [18]. For instance, inability to visualize the outcome of activities involving some degree of responsibility (such as closing doors, windows, stove, gas and water taps, and light switches) may lead to compulsive verification, specially early in illness, when patients are not severely disabled.

  • Transcranial magnetic brain stimulation modulates blepharospasm: A randomized controlled study

    2010, Neurology
    Citation Excerpt :

    rTMS also changed BRR in our patients with BEB to more physiologic levels after C-coil and H-coil stimulation. Diminished BRR habituation, which indicates the state of excitability of facial motoneurons and bulbar interneurons, has been well-documented in patients with BEB and other forms of dystonia.2,21 An animal model of blepharospasm suggests that a predisposing condition to develop BEB could be a loss of dopamine-containing neurons in the substantia nigra pars compacta causing a decreased inhibition in the blink circuit.22

View all citing articles on Scopus
View full text