Objective: To evaluate the relationship between mood/anxiety disorder severity and quality of life (QoL) domains in adult-onset idiopathic dystonia (AOID).

Background: Depression and anxiety exert a major influence on QoL in cervical and cranial forms of AOID, alongside social embarrassment, decreased self-esteem and social interaction, and visual restriction. Despite the complexity of the QoL construct, there is insufficient evidence on the domain-specific impact of these comorbidities in this population.

Method: Sixty-five patients with cranio-cervical AOID (age 58.7±10.8 years, 51 females) were enrolled. We used the Structured Clinical Interview for DSM-5 to assess lifetime/current history of depressive, anxiety or obsessive-compulsive and related disorders. We measured severity of psychiatric comorbidities using the Hospital Anxiety Depression Scale (HADS), Lebowitz Social Anxiety Scale (LSAS), Panic Disorder Severity Scale (PDSS), Generalized Anxiety Disorder-7, and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). We rated QoL with the Craniocervical dystonia questionnaire-24 (CDQ-24) and the EQ-5D-5L. For primary analysis, we measured paired correlation coefficients between psychiatric and QoL measures after botulinum toxin washout, adjusted for sex, age, Global Dystonia Rating Scale score, and current antidepressant use.

Results: Thirty-seven patients (56.9%) had a lifetime diagnosis of any depressive, anxiety or obsessive-compulsive and related disorder (60.8% F, 42.9% M), 25 of whom were never treated and 14% currently on antidepressants. HADS, Depression score correlated with the largest number of CDQ-24 (Pain, Activities of Daily Living, Social/Family Life; all p<0.0005) and EQ-5D-5L (Mobility, Selfcare, Usual Activities, Anxiety/Depression and Visual Analog Scale; all p<0.005) domains. We observed specific effects of HADS, Anxiety score on the Emotional Wellbeing domain of CDQ-24, of LSAS Fear/Anxiety sub-score on the Stigma domain of CDQ-24, and of the PDSS raw score on the Pain-Discomfort domain of EQ-5D-5L. Psychiatric scores did not improve 4-5 weeks after botulinum toxin injection.

Conclusion: Our findings confirm the impact of mood/anxiety problems on QoL in AOID. The observation of a domain-specific impact may inform the development of a personalized pathway of care for these still under-diagnosed and under-treated clinical comorbidities of AOID.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/domain-specific-impact-of-mood-anxiety-disorders-on-quality-of-life-in-idiopathic-dystonia/