Chronic dizziness: the interface between psychiatry and neuro-otology

Abstract

This paper reviews the often-enigmatic relationships between dizziness and psychiatric symptoms. Psychiatric causes of dizziness, neuro-otologic causes of anxiety, underrecognized co-morbid conditions, and medical illnesses that masquerade as 'psychogenic' dizziness are examined. Key clinical features and data from recent treatment trials are presented with potential pathophysiologic mechanisms. Investigations at the interface between psychiatry and neuro-otology have identified the distinguishing features of several clinical conditions that present with non-vertiginous dizziness, subjective imbalance, and psychiatric symptoms. The most common condition is chronic subjective dizziness; a refinement of earlier concepts of psychogenic dizziness, phobic postural vertigo, and space-motion phobia. Chronic subjective dizziness is consistent with advancing research on anxiety and somatoform disorders and offers greater insights into the relationships between neuro-otologic illnesses and anxiety. Migraine, post-concussional syndrome, and dysautonomias also cause persistent dizziness and may be misdiagnosed or malingering or psychogenic dizziness because they often present with comorbid psychiatric symptoms in the absence of identifiable vestibular deficits. Recent research has defined the key features of several medical-psychiatric conditions that cause chronic dizziness, permitting greater diagnostic precision and insight into underlying pathophysiologic processes. Treatment studies have identified potentially effective interventions, which must be evaluated in controlled clinical trials.