Dizziness and Panic Disorder: A Review of the Association Between Vestibular Dysfunction and Anxiety

Annals of Clinical Psychiatry - Tập 10 - Trang 75-80 - 1998
Naomi M. Simon1, Mark H. Pollack1, Kimberly S. Tuby1, Theodore A. Stern2
1Anxiety Disorders Program, Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston
2Avery D. Weissman Psychiatry Consultation Service, Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston

Tóm tắt

Dizziness is a common and costly condition that causes significant distress and impairment yet often confounds appropriate diagnosis and treatment. Among patients presenting for evaluation and treatment of dizziness, rates of panic disorder are elevated to 5 to 15 times the general population rates. In addition, the limited studies to date of dizziness in patients with panic disorder suggest that panic patients frequently experience significant dizziness and often demonstrate evidence of vestibular dysfunction. In this paper we review studies investigating the relationship between panic disorder and vestibular dysfunction. Currently, there are three main explanatory models for the association between panic disorder and vestibular dysfunction: the psychosomatic model, the somatopsychic model, and the network alarm theory. Systematic investigations of the treatment of patients with vestibular symptoms and panic disorder are lacking, though prevalence, associated costs, and disability suggest that they are needed. Serotonin selective reuptake inhibitors are good candidates for future treatment studies.

Tài liệu tham khảo

Kroenke K, Lucas C, Rosenberg ML, Scherokman B, Herbers JE Jr, Wehrle PA, Boggi JO: Causes of persistent dizziness: A prospective study of 100 patients in primary care. Ann Intern Med 1992; 177:898-904 Kroenke K, Mangelsdorff D: Common symptoms in ambulatory care: Incidence, evaluation, therapy and outcome. Am J Med 1989; 86:262-266 Stein MB, Asmundson GJG, Ireland D, Walker JR: Panic disorder in patients attending a clinic for vestibular disorders. Am J Psychiatry 1994; 151:1697-1700 Clark DB, Hirsch BE, Smith MG, Furman JMR, Jacob RG: Panic in otolaryngology patients presenting with dizziness or hearing loss. Am J Psychiatry 1994; 151:1223-1225 Frommberger UH, Tettenborn B, Butler R, Benkert O: Panic disorder in patients with dizziness. Arch Intern Med 1994; 154:590-591 Eagger S, Luxon LM, Davies RA, Coelho A, Ron MA: Psychiatric morbidity in patients with peripheral vestibular disorder: A clinical and neuro-otological study. J Neurol Neurosurg Psych 1992; 55:383-387 Katon W: Panic disorder and somatization: Review of 55 cases. Am J Med 1984; 77:101-106 Shurman RA, Cramer PD, Mitchell JB: The hidden mental health network: Treatment of mental illness by non-psychiatrist physicians. Arch Gen Psychiatry 1985; 442: 89-94 Yardley L, Putnam J: Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: A questionnaire study. Clin Otolaryngol 1992; 17: 231-236 Brandt T: Phobic postural vertigo. Neurology 1996; 46:1515-1519 Yardley L: Predication of handicap and emotional distress in patients with recurrent vertigo: Symptoms, coping strategies, control beliefs and reciprocal causation. Soc Sci Med 1994; 39:573-581 Yardley L, Luxon L, Haacke N: A longitudinal study of symptoms, anxiety and subjective well being in patients with vertigo. Clin Otolaryngol 1994; 19:109-116 Stephens S, Hogan S, Meredith R: The desynchrony between complaints and signs of disorders. Acta Otolaryngol 1991; 111:188-192 McKenna L, Hallam R, Hinchcliffe R: The prevalence of psychological disturbance in outpatients. Clin Otolaryngol 1991; 16:452-456 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Primary Care Version. Washington, DC: American Psychiatric Association; 1994 Yates BJ, Miller AD: Overview of vestibular autonomic regulation. In: Yates BJ, Miller AD, eds. Vestibular Autonomic Regulation. New York: CRC Press; 1996:1-3 Schor RH, Tomko DL: The vestibular system. In: Yates BJ, Miller AD, eds. Vestibular Autonomic Regulation. New York: CRC Press; 1996:7-24 Sved AF, Ruggiero DA: The autonomic nervous system structure and function. In: Yates BJ, Miller AD, eds. Vestibular Autonomic Regulation. New York: CRC Press; 1996:25-52 Simpson RB, Nedzelki JM, Barber HO, Thomas MR: Psychiatric diagnoses in patients with psychogenic dizziness or severe tinnitus. J Otolaryngol 1988; 17:325-330 Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Hans-Ulrich W, Kendler KS: Lifetime and twelve-month prevalence of DSM III-R psychiatric disorders in the United States: Results from the national study. Arch Gen Psychiatry 1994; 51:8-19 Sullivan M, Clark MR, Katon WJ, Fischl M, Russo J, Dobie RA, Voorhees R: Psychiatric and otologic diagnoses in patients complaining of dizziness. Arch Intern Med 1993; 153:1479-1484 Clark DB, Leslie MI, Jacob RG: Balance complaints and panic disorder: A clinical study of panic symptoms in members of a self-help group for balance disorders. J Anxiety Dis 1992; 6:47-53 Swinson RP, Cox BJ, Rutka J, Mai M, Kerr S, Kuch K: Otoneurological functioning in panic disorder patients with prominent dizziness. Comp Psychiatry 1993; 34:127-129 Jacob RG, Moller MB, Turner SM, Wall C: Otoneurological examination in panic disorder and agoraphobia with panic attacks: A pilot study. Am J Psychiatry 1985; 142:715-720 Jacob RG, Furman JM, Durrant JD, Turner SM: Panic, agoraphobia and vestibular dysfunction. Am J Psych 1996; 153:503-512 Sklare DA, Murray MB, Pikus AM, Uhde TW: Dysequilibrium and audiovestibular function in panic disorder: Symptom profiles and test findings. Am J Otology 1990; 11:338-341 Hoffman D, O'Leary D, Munjack D: Autorotation test abnormalities of the horizontal and vertical vestibuloocular reflexes in panic disorder. Otolaryngol-Head Neck Surg 1994; 110:259-269 Wertheim AH, van Gelder P, Lautin A, Peselow E, Cohen N: High thresholds for movement perception in schizophrenia may indicate abnormal extraneous noise levels of central vestibular activity. Biol Psychiatry 1985; 20:1197-1210 Jacob R: Panic disorder and the vestibular system. Psychiatr Clin North Am 1988; 11(2):361-374 Jacob RG, Furman JMR, Clark DB, Durrant JD: Vestibular symptoms, panic and phobia: Overlap and possible relationships. Ann Clin Psychiatry 1992; 4:163-174 Theunissen E, Huygen P, Folgering H: Vestibular hyperactivity and hyperventilation. Clin Otolaryngol 1986; 11:161-169 Yardley L, Watson S, Britton J, Lear S, Bird J: Effects of anxiety and arousal and mental stress on the vestibulo-ocular reflex. Acta Otolaryngol 1995; 115:597-602 Magnusson M, Pyykko I, Janetti V: Effect of alertness and visual attention on optokinetic nystagmus in humans. Am J Otolaryngol 1985; 6:419-425 Lillenfield S, Jacob R, Furman J: Vestibular dysfunction followed by panic disorder with agoraphobia. J Nerv Ment Dis 1989; 177:700-701 Pratt R, McKenzie W: Anxiety states following vestibular disorders. Lancet 1958; 16:347-349 Gordon A: Otoneurological abnormalities in agoraphobia. Am J Psychiatry 1986; 143:807-808 Marks I: Space “phobia”: A pseudo-agoraphobic syndrome. J Neurol Neurosurg Psych 1981; 44:387-391 Tavassoli M: Medical problems of space flight. Am J Med 1986; 81:850-854 Krystal J, Deutsch D, Charney D: The biological basis of panic disorder. J Clin Psychiatry 1996; 57(Suppl 10): 23-33 Cohen N: The dizzy patient: Update on vestibular disorders. Med Clin North Am 1991; 75:1251-1260 Gorman JM, Liebowitz MR, Fyer AJ, Stein J: A neuroanatomical hypothesis for panic. Am J Psychiatry 1989; 146:148-161 Barmack N, Pettorossi V: Vestibulo-ocular reflexes in rabbits: Reduction by intravenous injection of diazepam. Arch Neurol 1980; 37:718-722 Blair S, Gazin M: Modifications of the vestibulo-ocular reflex induced by diazepam: Experiments in the macaque. Arch Otolaryngol 1979; 105:698-701 Rascol O, Hain TC, Brefel C, Benzet M, Clanet M, Montastruc JL: Antivertigo medications and drug-induced vertigo: A pharmacological review. Drugs 1995; 50:777-791 Pollack MH, Smoller JS: Pharmacologic approaches to treatment-resistant panic disorder. In: Pollack MH, Otto MW, Rosenbaum JF, eds. Challenges in Clinical Practice: Pharmacologic and Psychosocial Strategies. New York: Guilford Press; 1996:89-112 Licata F, Li Volsi G, Maugeri G, Santangelo F: Effect of 5-hydroxytryptamine on the firing rates of neurons of the lateral vestibular nucleus in the rat. Exp Brain Res 1990; 79:293-298 Licata F, Li Volsi G, Maugeri G, Santangelo F: Excitatory and inhibitory effects of 5-hydroxytryptamine on the firing rate of medial vestibular nucleus neurons in the rat. Neurosci Lett 1993; 154:195-198 Licata F, Li Volsi G, Maugeri G, Ciranna L, Santangelo F: Serotonin evoked modifications of the neuronal firing rate in the superior vestibular nucleus: A microiontophoretic study in the rat. Neuroscience 1993; 52:941-949 Johnston AR, Murnion B, McQueen DS, Dutia MB: Excitation and inhibition of rat medial vestibular nucleus neurons by 5-hydroxytryptamine. Exp Brain Res 1993; 93:293-298 Jacobs B: 5-HT and motor control: A hypothesis. TINS 1993; 16:346-352 Schatzberg AF, Haddad PP, Kaplan EM, Lejoyeux M, Rosenbaum JF, Young AH, Zajecka J: Serotonin reuptake inhibitor discontinuation syndrome: A hypothetical definition. J Clin Psychiatry 1997; 58(Suppl 7):5-10 Coupland N, Bell, C, Potokar J: Serotonin reuptake inhibitor withdrawal. J Clin Psychopharmacol 1996; 16:356-362