Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet Muenchen, Langerstr 381675 Munich, Germany.
J Neurol Neurosurg Psychiatry. 2011 Jun;82(6):601-6. doi: 10.1136/jnnp.2010.237388. Epub 2011 Feb 4.
About 30-50% of complex dizziness disorders are organically not sufficiently explained or related to a psychiatric disorder. Of patients with such dizziness disorders, 80% are severely impaired by dizziness in their daily and working lives; nevertheless, they are often not diagnosed or treated adequately.
This review aims to give a systematic overview of psychotherapeutic approaches and their efficacy regarding the treatment of dizziness that is medically not sufficiently explained or related to a psychiatric disorder.
A systematic literature search was conducted in Medline, PSYNDEX and PsycINFO. Included in this systematic review were (randomised) controlled trials ((R)CTs) concerning psychotherapy in patients with dizziness, medically not sufficiently explained or associated with a psychiatric disorder. If possible, Hedges' g was used to express the effect sizes (ES) of the treatment. Heterogeneity was assessed using the Q statistic. In addition, the quality of the studies was rated.
Three (R)CTs were included. All studies used cognitive-behavioural treatment methods in combination with relaxation techniques or vestibular rehabilitation. All studies suggested that psychotherapy may provide improvement. The mean ES in the treatment groups was 0.46 (95% CI 0.05 to 0.88) for dizziness related outcome, 0.10 (-0.44 to 0.64) for anxiety and 0.17 (-0.24 to 0.58) for depression whereas in the control groups the mean dizziness related ES was -0.04 (-0.44 to 0.37), anxiety related ES was -0.03 (-0.43 to 0.38) and depression related ES was -0.02 (-0.42 to 0.38). The quality of the studies was average. Sample sizes were small, however, and there was a lack of long term studies.
This systematic review provides some preliminary evidence that psychotherapy may be effective in patients with dizziness that is medically not sufficiently explained or due to a psychiatric disorder. The results should be replicated in larger samples and follow-up RCTs.
大约 30-50%的复杂头晕障碍在医学上无法充分解释或与精神障碍有关。在有这种头晕障碍的患者中，80%的患者在日常生活和工作中因头晕而严重受损；然而，他们往往没有得到充分的诊断或治疗。
本综述旨在系统概述心理治疗方法及其对医学上无法充分解释或与精神障碍有关的头晕的疗效。
在 Medline、PSYNDEX 和 PsycINFO 中进行了系统的文献检索。本系统综述包括（随机）对照试验（RCT），涉及头晕患者的心理治疗，医学上无法充分解释或与精神障碍有关。如果可能，使用 Hedges'g 表示治疗效果大小（ES）。使用 Q 统计量评估异质性。此外，还对研究质量进行了评分。
纳入了三项 RCT。所有研究均采用认知行为治疗方法结合放松技术或前庭康复。所有研究均表明心理治疗可能提供改善。治疗组的平均 ES 为头晕相关结局 0.46（95%CI 0.05 至 0.88），焦虑 0.10（-0.44 至 0.64），抑郁 0.17（-0.24 至 0.58），而对照组头晕相关 ES 为-0.04（-0.44 至 0.37），焦虑相关 ES 为-0.03（-0.43 至 0.38），抑郁相关 ES 为-0.02（-0.42 至 0.38）。研究质量为中等。然而，样本量较小，且缺乏长期研究。
本系统综述提供了一些初步证据，表明心理治疗可能对医学上无法充分解释或与精神障碍有关的头晕患者有效。结果应在更大的样本量和随访 RCT 中得到复制。
