Staab Jeffrey P, Ruckenstein Michael J
Department of Psychiatry, Hospital of the University of Pennsylvania, Founders Pavilion F11.015, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Laryngoscope. 2003 Oct;113(10):1714-8. doi: 10.1097/00005537-200310000-00010.
OBJECTIVE To investigate the hypotheses that physical neurotologic conditions may trigger anxiety disorders (otogenic pattern of illness), that psychiatric disorders may produce dizziness (psychogenic pattern), and that risk factors for these syndromes may be identified. STUDY DESIGN Retrospective review of all patients (N = 132) treated at a tertiary care balance center from 1998 to 2002 for psychogenic dizziness with or without physical neurotologic illnesses. METHODS All patients underwent comprehensive neurotologic and psychiatric evaluations with attention to the longitudinal course of symptoms and risk factors for psychopathology. Patients were grouped according to the condition first causing dizziness. Risk factors were compared across groups. RESULTS Three equally prevalent patterns of illness were found: anxiety disorders as the sole cause of dizziness (33% of cases), neurotologic conditions exacerbating preexisting psychiatric disorders (34%), and neurotologic conditions triggering new anxiety or depressive disorders (33%). Panic disorder and agoraphobia were significantly more prevalent than less severe phobias in the first two groups, whereas the opposite pattern existed in the third group (P <.0001). More patients in the first two groups had risk factors for anxiety disorders (P <.05). Depression was not a primary cause of dizziness in any patient. Vestibular neuronitis, benign paroxysmal positional vertigo, and migraine were the most common neurotologic conditions. CONCLUSIONS These data support the hypothesis that physical neurotologic conditions may trigger psychopathology as often as primary anxiety disorders cause dizziness. A third pattern appears to be equally common wherein physical neurotologic conditions exacerbate preexisting psychiatric illnesses. Individuals at risk for anxiety disorders may be more likely to have primary psychopathology.
目的 探讨以下假说：躯体神经耳科疾病可能引发焦虑症（耳源性疾病模式）；精神疾病可能导致头晕（心因性模式）；以及可识别这些综合征的危险因素。研究设计 对1998年至2002年在一家三级医疗平衡中心接受治疗的所有患者（N = 132）进行回顾性研究，这些患者患有心因性头晕，伴有或不伴有躯体神经耳科疾病。方法 所有患者均接受了全面的神经耳科和精神科评估，重点关注症状的纵向病程和精神病理学的危险因素。患者根据最初导致头晕的情况进行分组。对各组的危险因素进行比较。结果 发现了三种同样常见的疾病模式：焦虑症是头晕的唯一原因（33%的病例）；神经耳科疾病加重了既往存在的精神疾病（34%）；神经耳科疾病引发了新的焦虑或抑郁障碍（33%）。在前两组中，惊恐障碍和广场恐惧症明显比不太严重的恐惧症更常见，而在第三组中则存在相反的模式（P <.0001）。前两组中更多患者有焦虑症的危险因素（P <.05）。抑郁症在任何患者中都不是头晕的主要原因。前庭神经炎、良性阵发性位置性眩晕和偏头痛是最常见的神经耳科疾病。结论 这些数据支持以下假说：躯体神经耳科疾病引发精神病理学的频率与原发性焦虑症导致头晕的频率相当。第三种模式似乎同样常见，即躯体神经耳科疾病加重了既往存在的精神疾病。有焦虑症风险的个体可能更易患原发性精神病理学疾病。
