Dizziness, migrainous vertigo and psychiatric disorders
Department of ENT, San Raffaele Hospital, Vita-Salute University, Milan, Italy. The Journal of Laryngology & Otology
(Impact Factor: 0.67).
12/2009; 124(3):285-90. DOI: 10.1017/S0022215109991976
This study sought to establish the prevalence of vestibular disorders, migraine and definite migrainous vertigo in patients with psychiatric disorders who were referred for treatment of dizziness, without a lifetime history of vertigo.
Out-patients in a university hospital.
Fifty-two dizzy patients with panic disorders and agoraphobia, 30 with panic disorders without agoraphobia, and 20 with depressive disorders underwent otoneurological screening with bithermal caloric stimulation. The prevalence of migraine and migrainous vertigo was assessed. The level of dizziness was evaluated using the Dizziness Handicap Inventory.
Dizzy patients with panic disorders and agoraphobia had a significantly p = 0.05 regarding the prevalence of peripheral vestibular abnormalities in the group of subjects with PD and agoraphobia and in those with depressive disorders. Migraine was equally represented in the three groups, but panic disorder patients had a higher prevalence of migrainous vertigo definite migrainous vertigo. Almost all patients with a peripheral vestibular disorder had a final diagnosis of definite migrainous vertigo according to Neuhauser criteria. These patients had higher Dizziness Handicap Inventory scores. The Dizziness Handicap Inventory total score was higher in the subgroup of patients with panic disorders with agoraphobia also presenting unilateral reduced caloric responses or definite migrainous vertigo, compared with the subgroup of remaining subjects with panic disorders with agoraphobia (p < 0.001).
Our data support the hypothesis that, in patients with panic disorders (and especially those with additional agoraphobia), dizziness may be linked to malfunction of the vestibular system. However, the data are not inconsistent with the hypothesis that migrainous vertigo is the most common pathophysiological mechanism for vestibular disorders.
Available from: Giampaolo Perna
- "Patients with PD and AG also showed high sensitivity to environmental light or bright stimuli, having photophobic behavior,35 abnormal retinal light responses, and pupillary reflex dysfunctions, possibly linked to serotonergic and/or dopaminergic function.36 Moreover, since a relationship between photosensitivity and migraine exists,37 and a high comorbidity of PD with AG and migraine was found,38 a broader dysfunction of autonomic and/or serotonergic systems may link photosensitivity, migraine, PAs, and AG.39 Overall, the findings of high sensitivity of patients with PD and AG to several stimuli in the surrounding environment support the idea that agoraphobic conditions may involve the activation of complex systems, beyond the simple fear of the recurrence of PAs, including emotional responses to destabilizing/unpleasant environmental situations and operant-learning processes related to the avoidance of physical experiences provoking discomfort in everyday life. "
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ABSTRACT: Although there are controversial issues (the "American view" and the "European view") regarding the construct and definition of agoraphobia (AG), this syndrome is well recognized and it is a burden in the lives of millions of people worldwide. To better clarify the role of drug therapy in AG, the authors summarized and discussed recent evidence on pharmacological treatments, based on clinical trials available from 2000, with the aim of highlighting pharmacotherapies that may improve this complex syndrome.
A systematic review of the literature regarding the pharmacological treatment of AG was carried out using MEDLINE, EBSCO, and Cochrane databases, with keywords individuated by MeSH research. Only randomized, placebo-controlled studies or comparative clinical trials were included.
After selection, 25 studies were included. All the selected studies included patients with AG associated with panic disorder. Effective compounds included selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, selective noradrenergic reuptake inhibitors, and benzodiazepines. Paroxetine, sertraline, citalopram, escitalopram, and clomipramine showed the most consistent results, while fluvoxamine, fluoxetine, and imipramine showed limited efficacy. Preliminary results suggested the potential efficacy of inositol; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy. More studies with the latter compounds are needed before drawing definitive conclusions.
No studies have been specifically oriented toward evaluating the effect of drugs on AG; in the available studies, the improvement of AG might have been the consequence of the reduction of panic attacks. Before developing a "true" psychopharmacology of AG it is crucial to clarify its definition. There may be several potential mechanisms involved, including fear-learning processes, balance system dysfunction, high light sensitivity, and impaired visuospatial abilities, but further studies are warranted.
Neuropsychiatric Disease and Treatment 10/2011; 7(1):621-37. DOI:10.2147/NDT.S12979 · 1.74 Impact Factor
Available from: Antonio E Nardi
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ABSTRACT: The purpose of this study was to evaluate the efficacy and effectiveness of imipramine on the treatment of comorbid chronic dizziness and panic disorder.
Nine patients with panic disorder and agoraphobia associated with chronic dizziness underwent otoneurological screening and were treated with a 3-months course of imipramine. Anxiety levels were measured with the Hamilton Anxiety Scale (HAM-A), dizziness levels were evaluated using the Dizziness Handicap Inventory (DHI), and panic severity and treatment outcome were assessed with the Clinical Global Impression Scale (CGI).
At the baseline 33.3% (n=3) had a bilateral peripheral deficit vestibulopathy, the mean scores for HAM-A were 27.2±10.4, for DHI were 51.7±22.7, and for CGI-S were 4.8±0.9. All patients had a significant reduction in their HAM-A (11.1±5.5, p=0.008), DHI (11.5±8.1, p=0.008) and CGI-I (1.8±0.7, p=0.011) levels after 3-months imipramine treatment (mean=72.2±23.2 mg/day).
This study found a decrease in anxiety levels and in the impact of dizziness in the patients' quality of life after a 3-months treatment course with imipramine.
Arquivos de neuro-psiquiatria 04/2011; 69(2A):196-201. DOI:10.1590/S0004-282X2011000200011 · 0.84 Impact Factor
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ABSTRACT: Shift work tolerance is a term describing the ability to adapt to shift work without adverse consequences. In this paper we systematically review literature published investigating the relation between individual differences such as age, gender, personality, morningness/eveningness as well as biological variables and different measures of shift work tolerance from 1998 till 2009. A total of 60 articles were included in this review, of which ten studies were classified as longitudinal, while the rest were classified as cross-sectional. Overall, the studies indicate that young age, male gender, low scores on morningness, high scores on flexibility and low scores on languidity, low scores on neuroticism, high scores on extraversion and internal locus of control and some genetic dispositions are related to higher shift work tolerance. More longitudinal studies, especially concerning personality, are needed to make conclusions about the predictive power of individual differences for shift work tolerance.
Sleep Medicine Reviews 08/2011; 15(4):221-35. DOI:10.1016/j.smrv.2010.07.002 · 8.51 Impact Factor
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