Botulinum Toxin Treatment of Spasmodic Torticollis: Effects on Psychosocial Function

Abstract

In torticollis, depression can be either secondary to the onset and experience of living with the illness or result from the primary central neurotransmitter dysfunction. The results of a number of previous studies have suggested that in torticollis depression may develop as a reaction to the postural abnormality of the head. One hundred patients with torticollis were more depressed than an equally chronic group of cervical spondylosis sufferers (Jahanshahi & Marsden, 1988). In torticollis, depression centered around a negative view of the self and disfigurement accounted for 14% of its variance (Jahanshahi & Marsden, 1990a). In a sample of 67 torticollis patients, a number of psychosocial variables (self-deprecation, satisfaction with available social support, maladaptive coping) together with disability and extent of control over head position accounted for 75% of the variance in depression. The self-deprecation associated with the negative body concept resulting from the postural abnormality emerged as the major predictor of depression (Jahanshahi, 1991). Longitudinal follow-up of these patients over 2.5 years showed that change in the clinical status of torticollis had a significant effect on depression, disability, and body concept (Jahanshahi & Marsden, 1990b).