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This term has been used by the University of Pittsburgh group to describe individuals with agoraphobia, acrophobia, and visual vertigo Jacob et al, The term has not been adopted by most others who work with dizzy patients, and we see no particular reason to use it instead of the root terms themselves. Some authors claim that exacerbation of dizziness and related symptoms by stimulating visual environments is typical of psychogenic vertigo Staab and Ruckenstein, More can be found on this symptom under the heading of visual dependence.

The difficulty of this assertion is that organic vertigo often results in sensitivity to visual environments. Another difficulty is that other authors claim the opposite, and that psychogenic vertigo is typified by increased dependence on somatosensory input Holmberg et al, In the author's opinion, these patterns reflect a sensory reweighting so that vestibular inputs are downweighted and replaced by greater dependence on anything else -- vision, somatosensory input, or internal estimates of bodily orientation and movement.

They are not necessarily psychogenic, and in fact, usually are accompanied by an organic vestibular disturbance. Psychological abnormalities in dizzy patients -- and keeping them in a reasonable perspective Psychological abnormalities are common in the general population, even more common in those who are ill, and are certainly also common in individuals with vertigo.

Models for associations between psychiatriac disorders and vestibular dysfunction. Psychosomatic model -- a primary psychiatric disturbance causes dizziness psychiatric chicken causes dizziness egg hyperventilation and hyperarrousal increased vestibular sensitivity. Somatopsychic model -- a primary inner ear disturbance causes anxiety. Increased anxiety increases misinterpretation.

Conditioning makes it persistent. Network alarm model -- renamed variant of somatopsychic model Panic is triggered by a "false alarm" via afferents to the locus ceruleus an area in the brain , which then triggers a "neuronal network", including limbic, midbrain and prefrontal areas.

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This explanation seems to us to be the "somatopsychic" model, renamed and attached to a specific brain localization. Non-localized vertigo At present there is no reliable method of consistently distinguishing among patients with dizziness caused by a psychiatric condition, nonlocalized dizziness, and the dizziness accompanied by a psychiatric condition. Non-localized vertigo in the acute care setting We define nonlocalized dizziness vertigo as the situation where there is reasonable probability that the patient has a structural disorder of the brain or inner ear, but there no objective evidence to substantiate this hypothesis.

Psychological Syndromes that can cause dizziness Psychogenic Vertigo Psychogenic dizziness or vertigo consists of a sensation of motion spinning, rocking, tilting, levitating etc. Panic Syndrome Anxiety and Panic: These are troubling diagnoses to make in dizzy patients, because there is an intrinsic ambiguity in causality -- between the chicken and egg -- are dizzy patients afraid of getting hurt, or are patients just so "worked up" that they are dizzy.

Somatization Syndrome The criteria for somatization syndrome requires between four and six unexplained symptoms, excluding dizziness. Depression While modest symptoms of depression are more common in dizzy patients Ketola et al, , patients will also point out that having an undiagnosed disabling illness can be accompanied by depression. Anxiety and Depression It is well recognized that anxiety may accompany vertigo Pollak et al, It seems unlikely that we need all of these terms.

Phobic postural vertigo PPV Brandt described a symptom complex that he termed "phobic postural vertigo" characterized by situationally triggered panic attacks, frequently including vertigo with unsteadiness. Using Brandt's words to be sure we identify what he is talking about: Patients complain about postural dizziness and subjective postural and gait unsteadiness without this being visible to an observer. Dizziness is described as a numbness with varying degrees of unsteadiness of posture and gait, attack-like fear of falling without any real falls, in part also unintentional body swaying of short duration.

The attacks often occur in typical situations known to be external triggers of other phobic syndromes e. During the course of the illness, the patient begins to generalise the complaints and increasingly to avoid the triggering stimuli. During or shortly after the attacks frequently mentioned only when asked , patients report anxiety and vegetative disturbances; most also report attacks of vertigo without anxiety. If asked, patients frequently report that the complaints improve after imbibing a little alcohol and during sports.

Frequently at the beginning, there is an organic vestibular illness, e.

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Patients with phobic postural vertigo often exhibit obsessive— compulsive and perfectionistic personality traits and during the course of the disease reactive—depressive symptoms. They stated: "Chronic subjective dizziness is a specific clinical syndrome with the cardinal feature of persistent nonspecific dizziness that cannot be explained by active medical conditions. Again, we remind the reader of what Clark pointed out , "The patient with chronic dizziness should never be labeled with psychogenic dizziness.

Persistent postural-perceptual dizziness PPPD. Post-traumatic stress syndrome PTSD Some attacks of vertigo are so psychologically stressing that they may cause psychological disorders usually panic or anxiety. Agoraphobia and acrophobia Agoraphobia, dread of being in or crossing open places, is usually considered a "functional" -- psychogenic, cause of dizziness. Coelho et al, Space and Motion Discomfort SMD This term has been used by the University of Pittsburgh group to describe individuals with agoraphobia, acrophobia, and visual vertigo Jacob et al, Visual vertigo Some authors claim that exacerbation of dizziness and related symptoms by stimulating visual environments is typical of psychogenic vertigo Staab and Ruckenstein, Vertigo and dizziness of functional origin.

Laryngoscope ; Ear, Nose and Throat ; Belal A, Glorig A.


Disequilibrium of aging presbyastasis. J Laryngol Otol ; Best, C. Eckhardt-Henn, et al. Results of a prospective longitudinal study over one year. Binder, L. Rohling Bittar, R. Lins Brandt T. Its multisensory syndromes. Springer Verlag, New York, Schultz, et al. Panic in otolaryngology patients presenting with dizziness or hearing loss. Am J Psychiatry ; Clark, M. Swartz Coelho, C. Waters, et al.

Dieterich, M. Staab Drachman D, Hart CW. An approach to the dizzy patient. Neurology ; Disequilibrium of unknown causes in older people. Ann Neurol ; Garcia FV and others. Psychological manifestations of vertigo: a pilot prospective observation study in a portuguese population.

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Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol ; Holmberg J. Phobic postural vertigo: body sway during vibratory proprioceptive stimulation. NeuroReport , Holmberg, J. Tjernstrom, et al.

Huppert, D. Strupp, et al.

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Panic disorder with vestibular dysfunction: further clinical observations and description of space and motion phobic stimuli. J Anx Dis, 3, , Jacob, R. Ketola, S. Havia, et al. Causes of Persistent dizziness. Ann Int Med ; Psychiatric disorders and functional impairment in patients with persistent dizziness.

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