めまい疾患における日常生活障害度に関連する心理学的特性について

Abstract

Vertigo and dizziness are known to be associated with comorbid psychological conditions such as anxiety and depression. In cases with dizziness persisting even after the near-disappearance of objective findings, such as nystagmus, the comorbid psychological condition could be conceived as being the cause of the chronic dizziness. Chronic dizziness may reduce a patient's social activities and deteriorate their quality of life. The Dizziness Handicap Inventory (DHI) is widely used in Europe and the United States as a measure of the degree of disability in daily life associated with subjective dizziness. The purpose of this study was to investigate the factors that affect the scores on the DHI, especially focusing on the psychological characteristics, in order to improve the deterioration of the quality of life caused by dizziness. This study was conducted in 211 patients diagnosed as having benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), vestibular migraine (VM), or vestibular neuritis (VN). The caloric test was used as the vestibular function test, and Self-rating Depression Scale (SDS), Geriatric Depression Scale-15 (GDS) and State-Trait Anxiety Inventory (STAI) were used as the questionnaires for the psychiatric assessments. In this study, we found no significant differences in the scores on the DHI or prevalence of depressive/anxiety tendencies depending on the causative disease underlying the dizziness. In patients with BPPV and MD, the high scores on trait anxiety and SDS increased the overall score on the DHI. The high scores on state anxiety and vestibular dysfunction also affected the overall DHI score in patients with MD. On the other hand, in patients with VN and VM, the psychiatric conditions had no effect on the overall DHI score. We consider that in vertigo patients with BPPV and MD, early evaluation of anxiety tendencies in patients of all ages and of depressive tendencies in those under the age of 65, and provision of psychological support to patients with depressive tendencies and characteristic anxiety tendencies may contribute to improving the QOL of the patients.