Background. While social anxiety has been reported among essential tremor (ET) patients, very little is known about the relation between self-report measures of social anxiety, tremor severity and disability, and cognition. Methods. Sixty-three individuals diagnosed with ET took part in a comprehensive study examining neurocognition and behavioral functioning. A psychiatric diagnostic interview, three social anxiety questionnaires, and an idiographic-based behavioral assessment to pinpoint anxiety provoking situations and related distress were completed. Results. Thirty percent of the participants met diagnostic criteria for social anxiety disorder (SAD). Social anxiety questionnaires were negligibly related to tremor severity and disability. Idiographic behavioral assessment of subjective distress was moderately related to resting tremor severity and disability and strongly related to social anxiety questionnaires scores. Only one cognitive variable was related to tremor severity. Conclusions. These findings suggest that (a) self-report measures of social anxiety with ET patients may underestimate distress; (b) emphasis on tremor severity may be misleading; (c) tremor disability may be a more sensitive and functional measure related to cognition and effect; (d) SAD is wide spread and does not appear to be related to dysregulated executive function; and (e) development of an ET-specific measure of social anxiety is called for. 1. Introduction Over the last 25 years, there has been a gradual acknowledgment that essential tremor (ET) is comprised of much more than a benign rhythmic oscillation of a limb [1–4]. A significant amount of data has been accumulated indicating ET is a multifaceted syndrome with multiple neurologic causal pathways, and, possibly, is a family of diseases [5]. Concurrent with closer examination of neurologic connections has been an increasing awareness of the breadth and magnitude of nonmotor symptoms, including cognition, disability and well-being [3, 4]. Evidence is emerging that ET is related to subtle, but significant cognitive impairment; however, the relationship between changes in cognition and nonmotor features of ET have rarely been examined [2, 3]. Data supporting impaired cognition is primarily based on clinic samples or individuals being considered for deep brain stimulation implant surgery. Such samples are not representative the population of individuals with ET and those patients who present for consideration of implant surgery are the most severe cases. Little is known about independent living, community dwelling,
References
[1]
K. L. Busenbark, J. Nash, S. Nash, J. P. Hubble, and W. C. Koller, “Is essential tremor benign?” Neurology, vol. 41, no. 12, pp. 1982–1983, 1991.
[2]
E. D. Louis, “Treatment of essential tremor: are there issues we are overlooking?” Frontiers in Neurology, vol. 2, article 91, 2011.
[3]
V. Chandran and P. K. Pal, “Essential tremor: beyond the motor features,” Parkinsonism and Related Disorders, vol. 18, no. 5, pp. 407–413, 2012.
[4]
E. D. Louis, “Essential tremor as a neuropsychiatric disorder,” Journal of the Neurological Sciences, vol. 289, no. 1-2, pp. 144–148, 2010.
[5]
E. D. Louis, “Essential tremors: a family of neurodegenerative disorders?” Archives of Neurology, vol. 66, no. 10, pp. 1202–1208, 2009.
[6]
W. S. Metzer, “Severe essential tremor compared with Parkinson's disease in male veterans: diagnostic characteristics, treatment, and psychosocial complications,” Southern Medical Journal, vol. 85, no. 8, pp. 825–828, 1992.
[7]
The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, The American Psychiatric Association, Washington, DC, USA, 4th edition, 2000.
[8]
D. A. Lundervold and R. Poppen, “Essential tremor and disability: a biobehavioral conditioning model,” Clinical Gerontologist, vol. 27, no. 4, pp. 31–40, 2004.
[9]
F. R. Schneier, L. F. Barnes, S. M. Albert, and E. D. Louis, “Characteristics of social phobia among persons with essential tremor,” Journal of Clinical Psychiatry, vol. 62, no. 5, pp. 367–372, 2001.
[10]
V. Top？uo？lu, Y. Bez, D. Sahin Bi？er et al., “Social phobia in essential tremor,” Turkish journal of psychiatry, vol. 17, no. 2, pp. 93–100, 2006.
[11]
D. H. Barlow, Clinical Handbook of Psychological Disorders: A Step By Step Treatment Manual, Guilford, New York, NY, USA, 3rd edition, 2008.
[12]
E. Othmer, E. C. Penick, B. J. Powell, M. R. Read, and S. C. Othmer, Psychiatric Diagnostic Interview-Revised (PDI-R), Western Psyhological Services, Los Angeles, Calif, USA, 2000.
[13]
D. A. Lundervold and R. Poppen, “Biobehavioral intervention for older adults coping with essential tremor,” Applied Psychophysiology Biofeedback, vol. 29, no. 1, pp. 63–73, 2004.
[14]
P. G. Bain, L. J. Findley, P. Atchison et al., “Assessing tremor severity,” Journal of Neurology Neurosurgery and Psychiatry, vol. 56, no. 8, pp. 868–873, 1993.
[15]
D. A. Lundervold, M. F. Belwood, J. L. Craney, and R. Poppen, “Reduction of tremor severity and disability following behavioral relaxation training,” Journal of Behavior Therapy and Experimental Psychiatry, vol. 30, no. 2, pp. 119–135, 1999.
[16]
D. A. Lundervold, R. Pahwa, P. A. Ament, and D. E. Corbin, “Validity of clinical and patient ratings of tremor disability among older adults,” Parkinsonism and Related Disorders, vol. 10, no. 1, pp. 15–18, 2003.
[17]
K. M. Connor, J. R. T. Davidson, L. Erik Churchill, A. Sherwood, E. Foa, and R. H. Weisler, “Psychometric properties of the social phobia inventory (SPIN). New self-rating scale,” British Journal of Psychiatry, vol. 176, pp. 379–386, 2000.
[18]
R. P. Mattick and J. C. Clarke, “Development and validation of measures of social phobia scrutiny fear and social interaction anxiety,” Behaviour Research and Therapy, vol. 36, no. 4, pp. 455–470, 1998.
[19]
E. J. Brown, J. Turovsky, R. G. Heimberg, H. R. Juster, T. A. Brown, and D. H. Barlow, “Validation of the social interaction anxiety scale and the social phobia scale across the anxiety disorders,” Psychological Assessment, vol. 9, no. 1, pp. 21–27, 1997.
[20]
R. G. Heimberg, G. P. Mueller, C. S. Holt, D. A. Hope, and M. R. Liebowitz, “Assessment of anxiety in social interaction and being observed by others: the Social Interaction Anxiety Scale and the Social Phobia Scale,” Behavior Therapy, vol. 23, no. 1, pp. 53–73, 1992.
[21]
M. D. Speigler and D. C. Guervremont, Contemporary Behavior Therapy, Wadsworth, Belmont, Calif, USA, 5th edition, 2010.
[22]
E. Kalbe, J. Kessler, P. Calabrese et al., “DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia,” International Journal of Geriatric Psychiatry, vol. 19, no. 2, pp. 136–143, 2004.
[23]
A. L. Benton, A. B. Sivan, K. des Hamsher, N. R. Varney, and O. Spreen, Contributions To Neuropsychological Assessment, Oxford University Press, New York, NY, USA, 2nd edition, 1994.
[24]
A. L. Benton and K. des Hamsher, Multilingual Aphasia Examination. Manual, University of Iowa, Iowa City, IA, Iowa, USA, 1994.
[25]
D. A. Lundervold, P. A. A. Ament, P. S. Holt, and E. Good, “A reexamination of the tremor disability scale-revised: a case control comparison,” in Proceedings of the 15th International Congress of Parkinson’s Disease and Movement Disorders, Toronto, Canada, June 2011.
[26]
O. Cohen, S. Pullman, E. Jurewicz, D. Watner, and E. D. Louis, “Rest tremor in patients with essential tremor: prevalence, clinical correlates, and electrophysiologic characteristics,” Archives of Neurology, vol. 60, no. 3, pp. 405–410, 2003.
[27]
S. P. Thawani, N. Schupf, and E. D. Louis, “Essential tremor is associated with dementia: prospective population-based study in New York,” Neurology, vol. 73, no. 8, pp. 621–625, 2009.
