Social phobia in spasmodic torticollis

Objectives-To study the prevalence of psychiatric comorbidity assessed by t he use of a structured clinical interview in a large, representative sample of patients with spasmodic torticollis (ST) and to test the hypothesis tha t social phobia would be highly prevalent. Methods-In a consecutive cohort of 116 patients with ST treated with botuli num toxin overall psychiatric comorbidity was studied prospectively with th e structured clinical interview (SCID) for DSM-IV axis I disorders. Physica l disability and psychosocial variables were also assessed with standardise d self rating questionnaires. Results-41.3% of the subjects met DSM-IV clinical criteria A-G for current social phobia as the primary psychiatric diagnosis. This figure rose to 56% including secondary and tertiary psychiatric diagnosis. There was no corre lation between severity of disease (Tsui score severity of pain, body image dissatisfaction score) and psychiatric comorbidity. The only significant p redictor of psychiatric comorbidity was depressive coping behaviour (logist ic regression analysis, p<0.01; OR=10.8). Compared with a representative sa mple of the general adult population, in the patients with SIC the prevalen ce of clinically relevant social phobia is 10-fold, of mood disorders 2.4-f old, and of lifetime psychiatric comorbidity 2.6-fold increased. Conclusions-A particularly high prevalence of social phobia was found in th e cohort of patients with ST. The finding of a high prevalence of social ph obia and depressive coping behaviour as the main predictor of psychiatric c omorbidity may make a subgroup of patients with ST particularly amenable to specific psychotherapeutic interventions.