Elyoseph Zohar, Geisinger Dario, Zaltzman Roy, Gordon Carlos R, Mintz Matti
School of Psychological Sciences, Tel Aviv University, Israel; The Center for Psychobiological Research, Department of Educationl Psychology and Educational Counseling, Max Stern Yezreel Valley College, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Israel.
J Neurol Sci. 2023 Jan 15;444:120530. doi: 10.1016/j.jns.2022.120530. Epub 2022 Dec 22.
Psychiatric Depersonalization/Derealization (DPDR) symptoms were demonstrated in patients with peripheral vestibular disorders. However, only semicircular canals (SCCs) dysfunction was evaluated, therefore, otoliths' contribution to DPDR is unknown. Also, DPDR symptoms in patients with central vestibular dysfunction are presently unknown. DPDR was also studied in the context of spatial disorientation and anxiety, but the relation of these cognitive and emotional functions to vestibular dysfunction requires clarification.
We tested patients with peripheral Bilateral Vestibular Hypofunction (pBVH), Machado Joseph Disease (MJD) with cerebellar and central bilateral vestibular hypofunction, and healthy controls. Participants completed the video Head Impulse Test (vHIT) for SCCs function, cervical Vestibular Evoked Myogenic Potentials test (cVEMPt) for sacculi function, Body Sensation Questionnaire (BSQ) for panic anxiety, Object Perspective-Taking test (OPTt) for spatial orientation and Cox & Swinson DPDR inventory for DPDR symptoms.
pBVH patients showed significant SCCs and sacculi dysfunction, spatial disorientation, elevated panic anxiety, and DPDR symptoms. MJD patients showed significant SCCs hypofunction but preserved sacculi function, spatial disorientation but normal levels of panic anxiety and DPDR symptoms. Only pBVH patients demonstrated a positive correlation between the severity of the DPDR and spatial disorientation and panic anxiety.
DPDR develops in association with sacculi dysfunction, either with or without SSCs dysfunction. Spatial disorientation and anxiety seem to mediate the transformation of vestibular dysfunction into DPDR symptoms. DPDR does not develop in MJD with central vestibular hypofunction but a normal saccular response. We propose a three-step model that describes the development of DPDR symptoms in vestibular patients.
外周前庭疾病患者存在精神性人格解体/现实解体（DPDR）症状。然而，以往仅评估了半规管（SCCs）功能障碍，因此，耳石对DPDR的影响尚不清楚。此外，目前尚不清楚中枢前庭功能障碍患者的DPDR症状。DPDR也在空间定向障碍和焦虑的背景下进行了研究，但这些认知和情感功能与前庭功能障碍的关系尚需阐明。
我们测试了外周双侧前庭功能减退（pBVH）患者、伴有小脑和中枢双侧前庭功能减退的马查多-约瑟夫病（MJD）患者以及健康对照者。参与者完成了用于评估SCCs功能的视频头脉冲试验（vHIT）、用于评估球囊功能的颈前庭诱发肌源性电位试验（cVEMPt）、用于评估惊恐焦虑的身体感觉问卷（BSQ）、用于评估空间定向的物体视角采择试验（OPTt）以及用于评估DPDR症状的考克斯和斯文森DPDR量表。
pBVH患者表现出显著的SCCs和球囊功能障碍、空间定向障碍、惊恐焦虑升高以及DPDR症状。MJD患者表现出显著的SCCs功能减退，但球囊功能保留，存在空间定向障碍，但惊恐焦虑和DPDR症状水平正常。仅pBVH患者的DPDR严重程度与空间定向障碍和惊恐焦虑之间存在正相关。
DPDR的发生与球囊功能障碍有关，无论是否伴有SSCs功能障碍。空间定向障碍和焦虑似乎介导了前庭功能障碍向前庭症状的转变。中枢前庭功能减退但球囊反应正常的MJD患者不会出现DPDR。我们提出了一个三步模型来描述前庭患者DPDR症状的发生发展。
