Speakers' abstract
Psychological impact of vertigo and balance disorders
Vertigo and balance (Part Two)
Luxon L, Chair of Audiovestibular Medicine, University of London
The prevalence of psychiatric disorders in patients with balance disorders is much higher than in the general population and in patients with persistent dizziness, such disorders have been demonstrated to be the second most common cause of symptoms, occurring in 10-25 percent of patients. Recent studies have demonstrated that the commonest psychiatric disorders associated with symptoms of disequilibrium are panic disorder, generalised anxiety disorder, phobic anxiety disorder and depression. More specific syndromes such as space phobia and the motorist disorientation syndrome have been described in patients with both peripheral (labyrinthine) and central (neurological) vestibular disorders. In a small percentage of patients, hyperventilation may compound the presentation of dizziness.
For the clinician evaluating a patient with disequilibrium, the common co-morbidity of psychological symptoms with vestibular disorders is important. In the past, patients have frequently been dismissed as simply being 'stressed' when their psychological symptoms have been precipitated by an underlying vestibular disorder. However, it is well recognised that vestibular compensation and symptomatic recovery are rarely effective in the presence of psychological symptoms, and it therefore behoves the clinician to be aware of the relationship between psychological illness and vestibular disease.
Self-rating questionnaires, such as the Hospital Anxiety and Depression Scale, the Beck Depression Inventory, the Fear Questionnaire, which detects phobic anxiety and avoidance behaviour, and the General Health Questionnaire, are of value in identifying psychiatric dysfunction as part of the overall clinical assessment. An effective treatment package for chronic disequilibrium addresses both the physical and psychological components of the disorder.