Objective: An International Parkinson and Movement Disorder Society subcommittee aimed to assess the quality of severity and screening instruments for depression, anxiety, apathy, OCD, mania, psychotic features, and personality profiles in dystonia.
Background: Psychiatric disorders, particularly depression and anxiety, are highly prevalent in patients with dystonia; however, it remains unclear whether appropriate clinical outcome assessment (COA) tools are available for clinicians and researchers.
Method: Following the methodology adopted by previous International Parkinson and Movement Disorder Society subcommittee papers, instruments used to assess psychiatric constructs in dystonia were reviewed and classified as “recommended,” “recommended with caveats,” “suggested,” or “listed.”
Results: Our review identified 29 COAs. The highest level which is “recommended” was assigned to three instruments: the Beck Anxiety Inventory, Hospital Anxiety and Depression Scale, and TWSTRS-Psych. Eight instruments were classified as “recommended with caveats,” including the Beck Depression Inventory, Montgomery–Åsberg Depression Rating Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Scale, State–Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Yale–Brown Obsessive Compulsive Scale, and the Dystonia Non-Motor Screening Tool. The main limitations include absence of dystonia-specific cut-off values; limited evidence for reliability metrics (e.g., test–retest reliability); insufficient evaluation of validity (e.g., known-groups and divergent validity); and limited evidence of responsiveness to change, particularly the minimum clinically meaningful change. The remaining were classified as “suggested”.
Conclusion: The high number of instruments “recommended with caveats” does not support developing new instruments for assessing psychiatric constructs in dystonia. However, addressing these caveats through new psychometric studies and revising existing instruments to improve nomenclature clarity are recommended next steps.
To cite this abstract in AMA style:
A. Wagle Shukla, K. Peall, D. Martino, G. Chan, S. Pandey, S. Rafee, V. Voros, M. Tijssen, N. Kovacs, M. Skorvanek. Clinical Outcome Assessments for Psychiatric Manifestations in Dystonia: Systematic Review, Critique, and Recommendations [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/clinical-outcome-assessments-for-psychiatric-manifestations-in-dystonia-systematic-review-critique-and-recommendations/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-outcome-assessments-for-psychiatric-manifestations-in-dystonia-systematic-review-critique-and-recommendations/