Abstract
Changes in depression, disability, body concept, and severity of head deviation were examined in a sample of 67 patients with idiopathic torticollis, who were reassessed 2 years after taking part in an initial study (before the use of botulinum toxin injections). Over the follow-up period, torticollis was unchanged in 41·8%, had improved in 26·9% and deteriorated in 31·3% of cases. The overall levels of depression, disability, and body concept across the two occasions did not change. Changes in the clinical severity of torticollis over the follow-up period had a significant effect on psychological adjustment. Those whose torticollis improved were less depressed and disabled and a had a more positive body concept compared to the patients whose torticollis had worsened. Measures of illness severity had stronger associations with measures of psychological adjustment at follow-up than at the time of initial study. Longer duration of torticollis was associated with larger increases in depression and disability during the 2 years of follow-up. The results suggest that the experience of depression, disability, and negative body concept in a proportion of torticollis sufferers is a reaction to the neurological illness. A minority of the patients who remain chronically depressed are primary candidates for therapeutic intervention aiming at improving their adjustment to the illness.
Highlights
Depression secondary to neurological disorder often remains undetected, as patients do not always report their depression and neurologists do not always enquire about mood (Bridges and Goldberg, 1984)
The change in the clinical status of torticollis over the follow-up period was based on the patients' own evaluations, evidence for its concurrent validity is available
The patients whose torticollis had deteriorated over the follow-up period had less head control, more disfigurement and higher pain severity at followup compared to the patients who had improved, despite their initial similarity in these clinical features on first assessment
Summary
Depression secondary to neurological disorder often remains undetected, as patients do not always report their depression and neurologists do not always enquire about mood (Bridges and Goldberg, 1984). It is conceivable that for a proportion of the patients who experience depression following the onset of a neurological disorder, the depression will have a chronic course, especially since the depression is likely to have remained undetected and untreated. Little information on this issue is available, as the majority of studies that have
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