Assessment and management of psychological problems in the dizzy patient

Research output: Contribution to journalArticle

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Abstract

Investigations over the last 20 years have moved the field of neuro-otology beyond the nonspecific concept of psychogenic dizziness to a more detailed understanding of interactions between neuro-otological and psychiatric disorders. Diagnostic studies of patients with Ménière's disease, vestibular neuritis, and benign paroxysmal positional vertigo suggest a model in which patients with predisposing factors, such as anxious temperaments or persistent anxiety during acute vestibular crises, are more likely to develop chronic dizziness with comorbid anxiety or depressive disorders. Outcome studies of patients with dizziness have shown that long-term disability depends more on psychological than physical factors. These medical-psychiatric interactions hold the keys to effective management of many patients with dizziness. Laboratory research has revealed neuroanatomical connections between central vestibular pathways and networks in the brain that control fear-related behavioral responses. These likely serve normal physiological functions in all individuals but appear to be the substrate for the close association between dizziness and anxiety in neuro-otological patients. Clinical studies of dizzy patients without active neuro-otological deficits have defined a syndrome of subjective dizziness and persistent imbalance known as phobic postural vertigo or chronic subjective dizziness. This syndrome can be reliably distinguished from other causes of chronic dizziness. Traumatic brain injuries, dysautonomias, and migraine headaches may cause a perplexing pattern of chronic or recurrent dizziness that is easily mistaken for a psychosomatic illness. Antidepressant medications, vestibular and balance rehabilitation therapy, and cognitive psychotherapy are showing increasing promise for treating both physical and psychological symptoms in patients with chronic dizziness due to various illnesses.

Original languageEnglish (US)
Pages (from-to)189-213
Number of pages25
JournalCONTINUUM Lifelong Learning in Neurology
Volume12
Issue number4
StatePublished - Aug 2006
Externally publishedYes

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Dizziness
Psychology
Psychiatry
Anxiety
Neurotology
Vestibular Neuronitis
Primary Dysautonomias
Temperament
Vertigo
Cognitive Therapy
Depressive Disorder
Anxiety Disorders
Migraine Disorders
Causality
Antidepressive Agents
Fear
Rehabilitation
Outcome Assessment (Health Care)
Brain

ASJC Scopus subject areas

  • Genetics(clinical)
  • Clinical Neurology

Cite this

Assessment and management of psychological problems in the dizzy patient. / Staab, Jeffrey P.

In: CONTINUUM Lifelong Learning in Neurology, Vol. 12, No. 4, 08.2006, p. 189-213.

Research output: Contribution to journalArticle

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