Tomić Aleksandra, Petrović Igor, Pešić Danilo, Vončina Marija Mitković, Svetel Marina, Mišković Nataša Dragašević, Potrebić Aleksandra, Toševski Dušica Lečić, Kostić Vladimir S
Clinic for Neurology, Clinical Centre of Serbia, Belgrade, Serbia.
Clinic for Neurology, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
J Psychosom Res. 2017 Jun;97:58-62. doi: 10.1016/j.jpsychores.2017.04.004. Epub 2017 Apr 12.
The aim of this cross-sectional study was to identify if there was a specific difference between patients with functional dystonia (DysF) and those with adult-onset, isolated idiopathic ("primary") dystonia (DysP) in terms of psychiatric disorders, psychological stressor, dissociation correlates, and personality traits.
Thirty-nine clinically definite DysF and 30 DysP patients matched by age, gender and dystonia distribution underwent psychiatric interview based on DSM-5 criteria and additional testings for global cognitive and psychiatric functions (Mini-Mental State Examination, Hamilton Depression and Hamilton Anxiety Rating Scale, Apathy Scale, Somatoform Dissociation Questionnaire-20, Dissociative Experiences Scale II, and the five-dimensional Revised Neuroticism-Extroversion-Openness Personality Inventory).
Almost half of our DysF patients had prior psychiatric treatment, which was significantly more frequent when compared to DysP. Patients with DysF in comparison to DysP also had considerably more frequent preceding stress, higher apathy, dissociative and somatoform scores, as well as significantly higher rate of la belle indifférence sign. This sign, stress before dystonia and prior psychiatric disorder independently predicted having DysF. Some of psychiatric disorders (i.e. substance-related disorders, schizophrenia, adjustment disorder, borderline personality disorder, post-traumatic stress disorder, psychotic depression, delusional disorder) were exclusively present among DysF patients. DysF compared to DysP patients had lower scores for both extroversion and openness to experiences.
Our data found different pattern of psychiatric comorbidity and personality traits between DysF and DysP patients, including a higher prevalence of psychological stressor and dissociative correlates, indicating at least a partial role of psychological mechanisms in the pathogenesis of DysF.
本横断面研究旨在确定功能性肌张力障碍（DysF）患者与成人起病的孤立性特发性（“原发性”）肌张力障碍（DysP）患者在精神疾病、心理应激源、解离相关因素和人格特质方面是否存在特定差异。
39例临床确诊的DysF患者和30例按年龄、性别和肌张力障碍分布匹配的DysP患者，根据DSM-5标准接受精神科访谈，并进行全球认知和精神功能的额外测试（简易精神状态检查表、汉密尔顿抑郁和汉密尔顿焦虑评定量表、淡漠量表、躯体形式解离问卷-20、解离体验量表II，以及五维修订的神经质-外向性-开放性人格量表）。
近一半的DysF患者曾接受过精神科治疗，与DysP患者相比，这一情况更为常见。与DysP患者相比，DysF患者先前经历应激的频率也更高，淡漠、解离和躯体形式得分更高，“泰然漠视”体征的发生率也显著更高。这种体征、肌张力障碍前的应激和先前的精神疾病独立预测患有DysF。一些精神疾病（即物质相关障碍、精神分裂症、适应障碍、边缘性人格障碍、创伤后应激障碍、精神病性抑郁、妄想障碍）仅在DysF患者中出现。与DysP患者相比，DysF患者的外向性和经验开放性得分较低。
我们的数据发现DysF和DysP患者在精神共病和人格特质方面存在不同模式，包括心理应激源和解离相关因素的患病率更高，这表明心理机制在DysF发病机制中至少起部分作用。
